Healthcare Provider Details

I. General information

NPI: 1568141117
Provider Name (Legal Business Name): COURTNEY JO SHIMP NICHOLS ARNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY JO SHIMP

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 5TH ST SE
OELWEIN IA
50662-2547
US

IV. Provider business mailing address

800 5TH ST SE
OELWEIN IA
50662-2547
US

V. Phone/Fax

Practice location:
  • Phone: 319-283-1908
  • Fax: 319-205-6513
Mailing address:
  • Phone: 319-283-1908
  • Fax: 319-205-6513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA175394
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: