Provider Demographics
NPI:1497281216
Name:CORNETT, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:CORNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:WHITESBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41858-0040
Mailing Address - Country:US
Mailing Address - Phone:606-633-4823
Mailing Address - Fax:
Practice Address - Street 1:464 KY HIGHWAY 699
Practice Address - Street 2:
Practice Address - City:CORNETTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41731-8749
Practice Address - Country:US
Practice Address - Phone:606-476-2593
Practice Address - Fax:606-476-2347
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY171890101Y00000X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor