Healthcare Provider Details

I. General information

NPI: 1720917545
Provider Name (Legal Business Name): COURTNEY MCKENNA HELLER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 LANDER RD
PEPPER PIKE OH
44124-4318
US

IV. Provider business mailing address

118 OLD ORCHARD DR
HUDSON OH
44236-2935
US

V. Phone/Fax

Practice location:
  • Phone: 440-449-4200
  • Fax:
Mailing address:
  • Phone: 330-931-8719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: