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NPI Code Detail

MEDICARE: COURTNEY PAIGE DETWILER

MEDICARE: COURTNEY PAIGE DETWILER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1285598987
Entity Type Code : Individual
Provider Name (Legal Business Name) : COURTNEY PAIGE DETWILER
Provider Business Mailing Address
First Line : 2253 CHARLES RD
Second Line :
City : OLIVE BRANCH
State : MS
Zip : 38654-9105
Country : US
Telephone Number : 765-215-5084
Fax Number :
Provider Business Practice Location Address
First Line : 2500 N STATE ST
Second Line :
City : JACKSON
State : MS
Zip : 39216-4500
Country : US
Telephone Number : 765-215-5084
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/16/2025
Last Update Date : 12/16/2025

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Directions to “ COURTNEY PAIGE DETWILER ” Practice Location

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