Healthcare Provider Details

I. General information

NPI: 1083096465
Provider Name (Legal Business Name): COURTNEY NELSON AGPCNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2015
Last Update Date: 06/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E COUNTY LINE RD SUITE 101
GREENWOOD IN
46143-1072
US

IV. Provider business mailing address

701 E COUNTY LINE RD SUITE 101
GREENWOOD IN
46143-1072
US

V. Phone/Fax

Practice location:
  • Phone: 317-885-2860
  • Fax: 317-885-2869
Mailing address:
  • Phone: 317-885-2860
  • Fax: 317-885-2869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number71005840A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number71005840A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: