Provider Demographics
NPI:1679234926
Name:O'CONNELL, CORY ANN (AGCNS-BC)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:ANN
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:AGCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13520 PIPING PLOVER DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-8097
Mailing Address - Country:US
Mailing Address - Phone:774-991-1996
Mailing Address - Fax:
Practice Address - Street 1:13520 PIPING PLOVER DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78729-8097
Practice Address - Country:US
Practice Address - Phone:774-991-1996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1018938364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology