Healthcare Provider Details

I. General information

NPI: 1184180051
Provider Name (Legal Business Name): COURTNEY BARLOW NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2019
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 MEMORIAL DR STE 280
BELLEVILLE IL
62226-5372
US

IV. Provider business mailing address

PO BOX 959203
SAINT LOUIS MO
63195-9203
US

V. Phone/Fax

Practice location:
  • Phone: 618-767-3235
  • Fax: 618-624-4982
Mailing address:
  • Phone: 618-767-3235
  • Fax: 618-624-4982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209017858
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209017858
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: