Healthcare Provider Details

I. General information

NPI: 1407155369
Provider Name (Legal Business Name): COURTNYE SIMMONS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2011
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 ROSA L PARKS AVE
MONTGOMERY AL
36105-1502
US

IV. Provider business mailing address

PO BOX 746063
ATLANTA GA
30374-6063
US

V. Phone/Fax

Practice location:
  • Phone: 334-777-1290
  • Fax: 334-746-7684
Mailing address:
  • Phone: 312-733-9730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-105148
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: