Healthcare Provider Details

I. General information

NPI: 1245152016
Provider Name (Legal Business Name): COURTNEY PATRICK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3667 COUNTY ROAD 2134 STE C
CADDO MILLS TX
75135-6897
US

IV. Provider business mailing address

215 COYOTE TRL
CADDO MILLS TX
75135-6561
US

V. Phone/Fax

Practice location:
  • Phone: 903-751-5550
  • Fax:
Mailing address:
  • Phone: 214-929-7923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1020919
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: