Provider Demographics
NPI:1740235779
Name:CORNWELL, KATHERINE E (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:E
Last Name:CORNWELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:E
Other - Last Name:BENDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:785 5TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-709-6529
Practice Address - Street 1:22 ST PAUL DR STE 201
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201
Practice Address - Country:US
Practice Address - Phone:717-217-6944
Practice Address - Fax:717-217-6955
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002292363AM0700X
PAMA-053677363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1007307260040OtherMEDICAID GROUP #
PA103165061 0001Medicaid
1007307260040OtherMEDICAID GROUP #
PA103165061 0001Medicaid