Healthcare Provider Details

I. General information

NPI: 1811608847
Provider Name (Legal Business Name): COURTNEY ANNE WILLIAMS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY WELLS

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 N 500 W
PROVO UT
84604-3380
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-357-7414
  • Fax:
Mailing address:
  • Phone: 801-357-7707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SN0000X
TaxonomyNeonatal Clinical Nurse Specialist
License Number6943363-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: