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NPI Code Detail

MEDICARE: COURTNEY PHENIX P.A.

MEDICARE: COURTNEY PHENIX P.A.
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
1363A00000XPhysician AssistantPA10801TX

General Provider Information

NPI Number : 1316399827
Entity Type Code : Individual
Provider Name (Legal Business Name) : COURTNEY PHENIX P.A.
Provider Business Mailing Address
First Line : 7442 S STAPLES ST
Second Line :
City : CORPUS CHRISTI
State : TX
Zip : 78413-5316
Country : US
Telephone Number : 361-991-0289
Fax Number :
Provider Business Practice Location Address
First Line : 7442 S STAPLES ST
Second Line :
City : CORPUS CHRISTI
State : TX
Zip : 78413-5316
Country : US
Telephone Number : 361-991-0289
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2016
Last Update Date : 12/10/2018

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Directions to “ COURTNEY PHENIX P.A.” Practice Location

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