| Doctor Name: | PHILLIP CORNISH |
| NPI Number: | 1982849071 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MSN, ANP-BC, FNP-BC |
| License Number: | 2011024678 |
| Business Practice Address: | 510 Waterside Dr Grover, MO - 630401634 |
| Business Phone Number: | 6189175930 |
| Business Fax Number: | |
| Mailing Address: | 510 Waterside Dr, GROVER |
| State: | MO |
| Postal Code: | 630401634 |
| Phone Number: | 6189175930 |
| Fax Number: | |
| NPI Enumeration Date: | 12/03/2008 |
| NPI Last Update Date: | 03/29/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 2011024678 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |