Provider Demographics
NPI:1962505123
Name:CORNUTT, ASHLEY MILLER (CRNA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MILLER
Last Name:CORNUTT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8305
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35902-8305
Mailing Address - Country:US
Mailing Address - Phone:256-546-5281
Mailing Address - Fax:256-546-7333
Practice Address - Street 1:1521 RAINBOW DR
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5395
Practice Address - Country:US
Practice Address - Phone:256-546-5281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-099443367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered