Provider Demographics
NPI:1194245027
Name:CORNETT, JOHANNA J (APRN)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:J
Last Name:CORNETT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 W ZERR RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-2795
Mailing Address - Country:US
Mailing Address - Phone:620-272-3600
Mailing Address - Fax:620-272-3606
Practice Address - Street 1:919 W ZERR RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846
Practice Address - Country:US
Practice Address - Phone:620-272-3600
Practice Address - Fax:620-272-3606
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-77674363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS77674OtherSTATE LICENSE