Provider Demographics
NPI:1598097545
Name:MOBILE HEALTHCARE, PLLC
Entity Type:Organization
Organization Name:MOBILE HEALTHCARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARNP
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:CORNETT
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:502-544-8704
Mailing Address - Street 1:111 COAKLEY LN
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:40068
Mailing Address - Country:US
Mailing Address - Phone:502-544-8704
Mailing Address - Fax:
Practice Address - Street 1:111 COAKLEY LN
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:KY
Practice Address - Zip Code:40068
Practice Address - Country:US
Practice Address - Phone:502-544-8704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-02
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5450P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100075620Medicaid