Healthcare Provider Details

I. General information

NPI: 1790406528
Provider Name (Legal Business Name): COURTNEY NICHOLE DAVIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2022
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 NORTH RACE ST
GLASGOW KY
42141
US

IV. Provider business mailing address

1412 NORTH RACE ST
GLASGOW KY
42141
US

V. Phone/Fax

Practice location:
  • Phone: 270-629-6333
  • Fax: 270-629-6334
Mailing address:
  • Phone: 270-629-6333
  • Fax: 270-629-6334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3018332
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: