Healthcare Provider Details

I. General information

NPI: 1124781208
Provider Name (Legal Business Name): COURTNEY CHEYENNE SCHWINN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2021
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 KENTUCKY AVE STE 501
PADUCAH KY
42003-3804
US

IV. Provider business mailing address

2605 KENTUCKY AVE
PADUCAH KY
42003-3800
US

V. Phone/Fax

Practice location:
  • Phone: 270-443-7534
  • Fax:
Mailing address:
  • Phone: 270-443-7534
  • Fax: 270-442-0309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number3016850
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: