Healthcare Provider Details

I. General information

NPI: 1205440328
Provider Name (Legal Business Name): COURTNEY LAVON PHILLIP FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2020
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 CONNECTICUT AVE NW STE 1250
WASHINGTON DC
20036-1728
US

IV. Provider business mailing address

4461 PLEASANT HILL CT
POMFRET MD
20675-3104
US

V. Phone/Fax

Practice location:
  • Phone: 202-627-1901
  • Fax: 415-252-7176
Mailing address:
  • Phone: 202-528-0971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR157014
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN967300
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: