Provider Demographics
NPI:1396706560
Name:CORK, YONG S (ARNP)
Entity type:Individual
Prefix:
First Name:YONG
Middle Name:S
Last Name:CORK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2914 SW PLASS CT
Mailing Address - Street 2:SUITE D
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66611-1925
Mailing Address - Country:US
Mailing Address - Phone:785-233-7138
Mailing Address - Fax:785-233-7089
Practice Address - Street 1:2914 SW PLASS CT
Practice Address - Street 2:SUITE D
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66611-1925
Practice Address - Country:US
Practice Address - Phone:785-233-7138
Practice Address - Fax:785-233-7089
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-060633-021163W00000X
KS46235363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200587880BMedicaid
KS006942Medicare PIN