Active NPI
Jacquelynn Cornell, P.T.
- Physical Therapist
- Kirkwood, MO
National Provider Identifier
1982899514
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT100396
- Practice address
- 439 S Kirkwood Rd
Ste 100
Kirkwood, MO 63122-6169 - Phone
- (314) 822-6297
- NPI assigned
- Sep 6, 2007
- Last updated
- Sep 6, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT100396 | MO | Primary |
Addresses
Primary practice location
439 S Kirkwood Rd
Ste 100
Kirkwood, MO 63122-6169
Mailing address
439 S Kirkwood Rd
Ste 100
Kirkwood, MO 63122-6169
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 |
|---|---|---|---|
| PT100396 | MO | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1189036800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1189036800000",
"number": "1982899514",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "439 S KIRKWOOD RD",
"address_2": "STE 100",
"city": "KIRKWOOD",
"state": "MO",
"postal_code": "631226169"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "439 S KIRKWOOD RD",
"address_2": "STE 100",
"city": "KIRKWOOD",
"state": "MO",
"postal_code": "631226169",
"telephone_number": "314-822-6297"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORNELL",
"first_name": "JACQUELYNN",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-09-06",
"last_updated": "2007-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MO",
"license": "PT100396",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kirkwood, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.