Tyler A Cornell, IDC

Primary specialty

Independent Duty CorpsmanTaxonomy code 1710I1002X

License

1215693759

Practice address

PSC 20090
Camp Lejeune, NC 28542-0090

Phone

(760) 453-4511

NPI assigned

Nov 9, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1636416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698105600000",
    "number": "1215693759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 WALNUT HILLS DR",
            "city": "RICHLANDS",
            "state": "NC",
            "postal_code": "285748346",
            "telephone_number": "760-453-4511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PSC 20090",
            "city": "CAMP LEJEUNE",
            "state": "NC",
            "postal_code": "285420090",
            "telephone_number": "760-453-4511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORNELL",
        "first_name": "TYLER",
        "middle_name": "A",
        "credential": "IDC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-11-09",
        "last_updated": "2023-10-24",
        "certification_date": "2023-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": null,
            "license": "1215693759",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sierra Grainger Cook, RDN, LDN
• Travis Alan Cook
• Clayton Joseph Cooke, MMT, MT-BC
• John Caleb Coomes, MD
• Paul David Cooper Jr., C.R.N.A.
• Colleen Alyssa Corrado
• Joseph Cosentino Jr., CRNA
• Sheila Dawn Costanzo, LPN
• James Franklin Cotton, FAMILY NURSE PRACTIT
• Courtney Cottrell, PHARMD

• Independent Duty Corpsman in Camp Lejeune, NC
• Providers in Camp Lejeune, NC by specialty
• Independent Duty Corpsman in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.