Active NPI
Lisa Kornegay
- Registered Nurse
- Greenwood, MS
National Provider Identifier
1932796505
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 916316
- Practice address
- 212 W Park Ave
Greenwood, MS 38930-3009 - Phone
- (662) 453-8505
- NPI assigned
- Dec 29, 2020
- Last updated
- Dec 29, 2020
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 916316 | MS | Primary |
Addresses
Primary practice location
212 W Park Ave
Greenwood, MS 38930-3009
Mailing address
212 W Park Ave
Greenwood, MS 38930-3009
Phone (662) 453-8505
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 916316 | MS | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mississippi CVS Pharmacy, L.L.C. | Past | Accepting new patients | |
| Mississippi CVS Pharmacy LLC | Past | Accepting new patients |
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1609200000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609200000000",
"number": "1932796505",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "212 W PARK AVE",
"city": "GREENWOOD",
"state": "MS",
"postal_code": "389303009",
"telephone_number": "662-453-8505"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "212 W PARK AVE",
"city": "GREENWOOD",
"state": "MS",
"postal_code": "389303009",
"telephone_number": "662-453-8505"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KORNEGAY",
"first_name": "LISA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-12-29",
"last_updated": "2020-12-29",
"certification_date": "2020-12-29",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MS",
"license": "916316",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greenwood, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.