Provider Demographics
NPI:1801156146
Name:CORNETT, KIRA LYNN (NP-C)
Entity type:Individual
Prefix:MRS
First Name:KIRA
Middle Name:LYNN
Last Name:CORNETT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:KIRA
Other - Middle Name:LYNN
Other - Last Name:MORRILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1858
Mailing Address - Street 2:
Mailing Address - City:ORACLE
Mailing Address - State:AZ
Mailing Address - Zip Code:85623
Mailing Address - Country:US
Mailing Address - Phone:520-404-0378
Mailing Address - Fax:
Practice Address - Street 1:910 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:ORACLE
Practice Address - State:AZ
Practice Address - Zip Code:85623
Practice Address - Country:US
Practice Address - Phone:520-404-0378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2021-12-09
Deactivation Date:2020-10-22
Deactivation Code:
Reactivation Date:2021-08-13
Provider Licenses
StateLicense IDTaxonomies
AZ257995363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily