Healthcare Provider Details

I. General information

NPI: 1982128716
Provider Name (Legal Business Name): KELSIE MAUREEN COURT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 S BROADWAY AVE
TYLER TX
75701-4214
US

IV. Provider business mailing address

PO BOX 746079
ATLANTA GA
30374-6079
US

V. Phone/Fax

Practice location:
  • Phone: 903-201-8664
  • Fax:
Mailing address:
  • Phone: 773-352-1515
  • Fax: 312-929-0379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberS8973
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: