Healthcare Provider Details

I. General information

NPI: 1912992116
Provider Name (Legal Business Name): KATHLEEN F COURTNEY C.F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 05/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 BRYANT ST
BUFFALO NY
14222-2006
US

IV. Provider business mailing address

50 BRIGHAM RD
FREDONIA NY
14063-1004
US

V. Phone/Fax

Practice location:
  • Phone: 716-878-7000
  • Fax:
Mailing address:
  • Phone: 716-673-1761
  • Fax: 716-672-7691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF334067-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: