Healthcare Provider Details

I. General information

NPI: 1073918637
Provider Name (Legal Business Name): BRIAN COURTNEY FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2014
Last Update Date: 04/28/2023
Certification Date: 04/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 GOLF COURSE RD NW STE A387120
ALBUQUERQUE NM
87120-5842
US

IV. Provider business mailing address

1250 S CLEARVIEW AVE SUITE 100
MESA AZ
85209-3378
US

V. Phone/Fax

Practice location:
  • Phone: 505-800-7070
  • Fax:
Mailing address:
  • Phone: 480-988-9108
  • Fax: 480-813-4460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP7374
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: