Healthcare Provider Details

I. General information

NPI: 1164990669
Provider Name (Legal Business Name): COURTNEY LYNN ATKINSON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2018
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 W CARO RD
CARO MI
48723
US

IV. Provider business mailing address

1525 W CARO RD
CARO MI
48723-9686
US

V. Phone/Fax

Practice location:
  • Phone: 989-660-9272
  • Fax: 989-672-0748
Mailing address:
  • Phone: 989-660-9272
  • Fax: 989-672-0748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704282883
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: