Active NPI
Carol Ann Cornett, PA-C
- Physician Assistant
- Saint Louis, MO
National Provider Identifier
1639426752
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 2017029444
- Practice address
- 8612 Olive Blvd
Saint Louis, MO 63132-2504 - Phone
- (314) 692-8055
- Fax
- (314) 692-5513
- NPI assigned
- Aug 8, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA 9106633 | FL | |
| Physician Assistant | 363A00000X | 2017029444 | MO | Primary |
Addresses
Primary practice location
8612 Olive Blvd
Saint Louis, MO 63132-2504
Mailing address
8612 Olive Blvd
Saint Louis, MO 63132-2504
Phone (314) 692-8055
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA 9106633 | Other | FL | STATE OF FLORIDA LICENSE |
| 2017029444 | Other | MO | STATE OF MISSOURI LICENSE |
Other names 1
- Carol Ann James
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA 9106633 | FL | MD | Medical Physician Assistant |
Interoperability endpoints
- https://api.platform.athenahealth.com/12355/brand/1/csg/1/fhir/r4
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1344384000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1512518400000",
"number": "1639426752",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8612 OLIVE BLVD",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631322504",
"telephone_number": "314-692-8055",
"fax_number": "314-692-5513"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8612 OLIVE BLVD",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631322504",
"telephone_number": "314-692-8055",
"fax_number": "314-692-5513"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORNETT",
"first_name": "CAROL",
"middle_name": "ANN",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-08-08",
"last_updated": "2017-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "FL",
"license": "PA 9106633",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MO",
"license": "2017029444",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF FLORIDA LICENSE",
"identifier": "PA 9106633",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF MISSOURI LICENSE",
"identifier": "2017029444",
"state": "MO"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "CAROL",
"last_name": "JAMES",
"middle_name": "ANN",
"credential": "PA-C",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.