Healthcare Provider Details

I. General information

NPI: 1851135180
Provider Name (Legal Business Name): COURTNEY LYNN NOVELLA MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 S WELLS ST
EDNA TX
77957-4045
US

IV. Provider business mailing address

541 COUNTY ROAD 319
EDNA TX
77957-4994
US

V. Phone/Fax

Practice location:
  • Phone: 361-782-7820
  • Fax:
Mailing address:
  • Phone: 361-235-0427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1167482
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: