Provider Demographics
NPI:1760938047
Name:CLELAND, COREY WJ (FNP)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:WJ
Last Name:CLELAND
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 VILLAGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862
Mailing Address - Country:US
Mailing Address - Phone:865-429-8800
Mailing Address - Fax:865-429-4310
Practice Address - Street 1:1110 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-5028
Practice Address - Country:US
Practice Address - Phone:865-429-8800
Practice Address - Fax:865-429-4310
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21406363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care