Richard A Corley, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9102574 Issued in FL

Practice address

10820 Marvin E Jones Blvd
Live Oak, FL 32060

Phone

(386) 658-5300

Fax

(386) 658-5130

NPI assigned

Nov 16, 2006

Last updated

Dec 21, 2009By the provider in NPPES

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Acv Community Services LLC

  • Rural Health Clinic/Center
  • Live Oak, FL
  • NPI 1174630693
  NPD (past)
• Wythe County Physician Practices LLC

  • Diagnostic Radiology Physician
  • Wytheville, VA
  • NPI 1457168494
  NPD (past)

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

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1261353600000",
    "number": "1417020314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10820 MARVIN E. JONES BLVD.",
            "city": "LIVE OAK",
            "state": "FL",
            "postal_code": "32060",
            "telephone_number": "386-658-5300",
            "fax_number": "386-658-5130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10820 MARVIN E JONES BLVD",
            "city": "LIVE OAK",
            "state": "FL",
            "postal_code": "32060",
            "telephone_number": "386-658-5300",
            "fax_number": "386-658-5130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORLEY",
        "first_name": "RICHARD",
        "middle_name": "A",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-16",
        "last_updated": "2009-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9102574",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MEDICAID",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Conscious Contact Services LLC
• Michele Cook, B.S. SLPA
• Nicole Maria Cooke, PMHNP-BC
• Mary Cooper
• Coproviders
• Cornerstone Care Clinic LLC
• Crater Lake Emergency Physicians LLC
• Stephanie Suzanne Crowe, M.S.
• Tracy L Crutchfield, ED.D., PSY.S.
• Taylor Cumbess, B.S. E.D. SLP-A

• Physician Assistant in Live Oak, FL
• Providers in Live Oak, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2009; 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.