Healthcare Provider Details

I. General information

NPI: 1639512601
Provider Name (Legal Business Name): COURTNEY MICHELE JAMES M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2013
Last Update Date: 10/28/2024
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10273 GOULD DRIVE
ST. FRANCISVILLE LA
70775
US

IV. Provider business mailing address

PO BOX 368 OAK BUILDING
ST. FRANCISVILLE LA
70775
US

V. Phone/Fax

Practice location:
  • Phone: 225-635-9065
  • Fax: 225-635-9069
Mailing address:
  • Phone: 225-635-9065
  • Fax: 225-635-9069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number302489
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: