Provider Demographics
NPI:1801265947
Name:CORNELL, KATHLEEN R (NP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:R
Last Name:CORNELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:107 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-6507
Mailing Address - Country:US
Mailing Address - Phone:508-477-7090
Mailing Address - Fax:507-477-3909
Practice Address - Street 1:848 ROUTE 50
Practice Address - Street 2:
Practice Address - City:BURNT HILLS
Practice Address - State:NY
Practice Address - Zip Code:12027
Practice Address - Country:US
Practice Address - Phone:518-831-1500
Practice Address - Fax:518-280-8464
Is Sole Proprietor?:No
Enumeration Date:2015-09-18
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF339768363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner