Provider Demographics
NPI:1376805911
Name:CORTER, MENDY BETH (PA)
Entity type:Individual
Prefix:MS
First Name:MENDY
Middle Name:BETH
Last Name:CORTER
Suffix:
Gender:F
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:1003 SCHNEIDER DR
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:AR
Mailing Address - Zip Code:72104-4811
Mailing Address - Country:US
Mailing Address - Phone:501-337-5678
Mailing Address - Fax:501-332-6759
Practice Address - Street 1:9851 BROOK RD
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-4559
Practice Address - Country:US
Practice Address - Phone:804-893-8702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110009651363A00000X
ARP-T1221363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP-T1221OtherMEDICAL LICENSE