Healthcare Provider Details

I. General information

NPI: 1366233066
Provider Name (Legal Business Name): COURTNEY HEWITT
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 09/06/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HAIRPIN DR
EDWARDSVILLE IL
62026-0001
US

IV. Provider business mailing address

1 HAIRPIN DR
EDWARDSVILLE IL
62026-0001
US

V. Phone/Fax

Practice location:
  • Phone: 618-650-3956
  • Fax:
Mailing address:
  • Phone: 618-650-3956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15646500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number360791
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: