Healthcare Provider Details

I. General information

NPI: 1225849813
Provider Name (Legal Business Name): MARGIE COURTNEY RN, BSN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2025
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 8TH AVE
FORT WORTH TX
76104-4110
US

IV. Provider business mailing address

1212 CREST DR
COLLEYVILLE TX
76034-4143
US

V. Phone/Fax

Practice location:
  • Phone: 817-698-8941
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number1018872
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: