Basic Information
| Provider Information | |||||||||
| NPI: | 1144277815 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CORBETT | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | ALAN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN, FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 W NIFONG BLVD, BLDG. 1 | ||||||||
| Address2: | STE 501 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652035615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5732341800 | ||||||||
| FaxNumber: | 5732341799 | ||||||||
| Practice Location | |||||||||
| Address1: | 2511 W EDGEWOOD DR | ||||||||
| Address2: | STE D | ||||||||
| City: | JEFFERSON CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 651095869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5737612121 | ||||||||
| FaxNumber: | 5736350726 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2006 | ||||||||
| LastUpdateDate: | 06/13/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 142061 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 429284417 | 05 | MO | MEDICAID |