Healthcare Provider Details

I. General information

NPI: 1861951162
Provider Name (Legal Business Name): COURTNEY ANN HORTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2019
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14720 MAIN ST NE STE 109
DUVALL WA
98019-8460
US

IV. Provider business mailing address

14720 MAIN ST NE STE 109
DUVALL WA
98019-8460
US

V. Phone/Fax

Practice location:
  • Phone: 425-788-4889
  • Fax:
Mailing address:
  • Phone: 425-788-4889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD61192497
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: