Provider Demographics
NPI:1891997060
Name:CORNETT, PARKER (ATC)
Entity Type:Individual
Prefix:
First Name:PARKER
Middle Name:
Last Name:CORNETT
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MCBRIDE CLINIC, INC.
Mailing Address - Street 2:400 N BRYANT
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034
Mailing Address - Country:US
Mailing Address - Phone:405-230-9200
Mailing Address - Fax:405-330-5591
Practice Address - Street 1:MCBRIDE CLINIC, INC.
Practice Address - Street 2:400 N BRYANT
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034
Practice Address - Country:US
Practice Address - Phone:405-230-9200
Practice Address - Fax:405-330-5591
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK456247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other