Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | 114257 | KY |
NPI | 1225500085 |
---|---|
Provider Name | Mr. Stephen Daniel Cornett |
First Address | Lexington, KY 40503-3900 |
Second Address | Lexington, KY 40503-3900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2018 |
Last Update Date | 18/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
114257 | KENTUCKY BOARD OF EXAMINERS OF PSYCHOLOGY (01) | KY |