KELLI CLEBERT CORKERN (NPI# 1629353990) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629353990 |
| Entity Type | Individual |
| Full Name | KELLI CLEBERT CORKERN |
| Other Name | KELLI BRIDGETTE CLEBERT |
| Credential | NP |
| Practice Address |
2647 S Saint Elizabeth Blvd Ste 100 Gonzales LA 70737-5019 |
| Mailing Address |
5959 S Sherwood Forest Blvd Baton Rouge LA 70816-6038 |
| Practice Telephone | 2256478511 |
| Practice Fax Number | 2256445415 |
| Mailing Telephone | 2255260001 |
| Mailing Fax Number | 2257659196 |
| Enumeration Date | 2011-10-18 |
| Last Update Date | 2017-10-19 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
AP06551 | LA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 07508799 | 05 | |
| LA | 2169149 | 05 |
| Street Address |
2647 S SAINT ELIZABETH BLVD STE 100 |
| City | GONZALES |
| State | LA |
| Zip Code | 70737-5019 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407461593 | Scott G Petrie Md Apmc | Non-Pharmacy Dispensing Site | 1014 West St Clare Boulevard, Ste 1020, Gonzales, LA 70737 | 2020-09-15 |
| 1407461981 | Bryant Louis Bourgeois | Dentist | 13317 N Burnside, Gonzales, LA 70737 | 2020-09-11 |
| 1821612631 | Kene Anje Hamilton | Behavioral Analyst | 1028 East Worthy Street, Gonzales, LA 70737 | 2020-06-08 |
| 1801428636 | Mercedes Francis | Behavior Technician | 1023 E W Worthy Rd, Gonzales, LA 70737 | 2020-02-10 |
| 1407347586 | Functional Dme | Prosthetic/Orthotic Supplier | 219 W. Eastbank St., Ste B, Gonzales, LA 70737 | 2018-05-23 |
| 1235631789 | Transporting On Purpose | Non-emergency Medical Transport (VAN) | 42148 Conifer Drive, Gonzales, LA 70737 | 2018-03-01 |
| 1215453121 | Michelle Fuller Harris | Social Worker | 39094 N Angelle Ct, Gonzales, LA 70737 | 2017-08-22 |
| 1215452529 | Lani Litchfield | Specialist/Technologist | 13341 W. Mill Grove Dr, Gonzales, LA 70737 | 2017-08-08 |
| 1326569369 | Tyler Joshua Turner | Counselor | 1923 South Edwards, Gonzales, LA 70737 | 2017-06-29 |
| 1518408046 | Margaret Madere | Social Worker | 2827 S Ruby Street, Gonzales, LA 70737 | 2017-03-16 |
| Find all providers in zip 70737 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316575749 | Michelle Coleman | Nurse Practitioner | 610 E Great Haven St, Gonzales, LA 70737-4877 | 2020-03-31 |
| 1760017305 | Diversified Medical Services, LLC | Nurse Practitioner | 2305 S Purpera Ave, Gonzales, LA 70737-5427 | 2020-03-04 |
| 1285264549 | Shambrel Nicole Bates | Nurse Practitioner | 40436 Cross Creek Ave, Gonzales, LA 70737-0716 | 2020-01-24 |
| 1073095204 | Megan Louque Stamps | Nurse Practitioner | 1201 S Purpera Ave Ste 601, Gonzales, LA 70737-4379 | 2018-09-04 |
| 1568903326 | Karen Ovide Skidmore | Nurse Practitioner | 1014 Saint Clair Blvd Ste 3000, Gonzales, LA 70737-5023 | 2017-03-13 |
| 1053729913 | Jennifer Jennings Gibson | Nurse Practitioner | 2524 S Philippe Ave, Gonzales, LA 70737-3749 | 2014-07-23 |
| 1750722336 | Sarah Bankert | Nurse Practitioner | 1943 S Burnside Ave, Gonzales, LA 70737-4632 | 2013-07-11 |
| 1558602664 | Lindsay Renee Burner | Nurse Practitioner | 6473 Highway 44 Ste 103, Gonzales, LA 70737-8179 | 2013-03-14 |
| 1104120138 | Hailey Entremont | Nurse Practitioner | 2647 S Saint Elizabeth Blvd Ste 311, Gonzales, LA 70737-5020 | 2011-01-05 |
| 1356516157 | Mary Ayleene Ritter | Nurse Practitioner | 6473 Highway 44, Ste 103, Gonzales, LA 70737-8179 | 2008-04-23 |
| Find all providers in GONZALES | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.