Healthcare Provider Details

I. General information

NPI: 1306780721
Provider Name (Legal Business Name): COURTNEY HENRY PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10978 BUCKLEY HALL RD
MATHEWS VA
23109-2319
US

IV. Provider business mailing address

10978 BUCKLEY HALL RD
MATHEWS VA
23109-2319
US

V. Phone/Fax

Practice location:
  • Phone: 804-725-3041
  • Fax: 804-725-3510
Mailing address:
  • Phone: 804-456-8105
  • Fax: 804-725-3510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024197118
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: