Healthcare Provider Details

I. General information

NPI: 1770040941
Provider Name (Legal Business Name): COURTNEY CHLOE WRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2019
Last Update Date: 02/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 SARDIS DR
BOAZ AL
35956-2139
US

IV. Provider business mailing address

134 COUNTY ROAD 831
BOAZ AL
35957-7769
US

V. Phone/Fax

Practice location:
  • Phone: 256-593-9999
  • Fax: 256-593-9141
Mailing address:
  • Phone: 256-659-8381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-138745
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: