Healthcare Provider Details

I. General information

NPI: 1124544820
Provider Name (Legal Business Name): COURTNEY JORDAN RABB DNP, APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2017
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 E HIGHLAND MALL BLVD STE 305
AUSTIN TX
78752-3731
US

IV. Provider business mailing address

314 E HIGHLAND MALL BLVD STE 305
AUSTIN TX
78752-3731
US

V. Phone/Fax

Practice location:
  • Phone: 512-807-0640
  • Fax:
Mailing address:
  • Phone: 512-807-0640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number838879
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1179847
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: