Healthcare Provider Details

I. General information

NPI: 1780074518
Provider Name (Legal Business Name): COURTNEY R TRIPLETT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2015
Last Update Date: 04/14/2023
Certification Date: 04/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 WATER ST STE 435
BILOXI MS
39530-4220
US

IV. Provider business mailing address

770 WATER ST STE 435
BILOXI MS
39530-4220
US

V. Phone/Fax

Practice location:
  • Phone: 228-355-2735
  • Fax:
Mailing address:
  • Phone: 228-355-2735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number915770
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number915770
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number915770
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number319080-31
License Number StateWI
# 5
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number915770
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: