Provider Demographics
NPI:1598170433
Name:CORNELLA, RACHEL L (NP)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:L
Last Name:CORNELLA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:706 W BEN WHITE BLVD
Mailing Address - Street 2:BLDG A, STE 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7034
Mailing Address - Country:US
Mailing Address - Phone:512-442-1996
Mailing Address - Fax:512-441-1093
Practice Address - Street 1:706 W BEN WHITE BLVD
Practice Address - Street 2:BLDG A, STE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7034
Practice Address - Country:US
Practice Address - Phone:512-442-1996
Practice Address - Fax:512-441-1093
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125821363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX360002YLPSOtherWELLMED PTAN
TX338017201Medicaid