Healthcare Provider Details

I. General information

NPI: 1124489679
Provider Name (Legal Business Name): COURTNEY LITTLE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2016
Last Update Date: 06/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26901 US HIGHWAY 119 N
BELFRY KY
41514-7520
US

IV. Provider business mailing address

100 AIRPORT GARDENS ROAD STE 311
HAZARD KY
41701-9529
US

V. Phone/Fax

Practice location:
  • Phone: 606-237-0327
  • Fax: 606-237-6624
Mailing address:
  • Phone: 606-487-7503
  • Fax: 606-439-6927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3010052
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: