Healthcare Provider Details

I. General information

NPI: 1417611146
Provider Name (Legal Business Name): KOURTNIE OGBURN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2021
Last Update Date: 10/28/2021
Certification Date: 10/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 DENNIS FLAT RD
DEETH NV
89823-8982
US

IV. Provider business mailing address

PO BOX 57
DEETH NV
89823-0057
US

V. Phone/Fax

Practice location:
  • Phone: 775-340-8580
  • Fax:
Mailing address:
  • Phone: 775-340-8580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: