Provider Demographics
NPI:1285382085
Name:VANPELT, COREY CHARLES
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:CHARLES
Last Name:VANPELT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 CRIMSON CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-1225
Mailing Address - Country:US
Mailing Address - Phone:470-774-1992
Mailing Address - Fax:
Practice Address - Street 1:1803 CRIMSON CT
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-1225
Practice Address - Country:US
Practice Address - Phone:470-774-1992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12108968172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver