Healthcare Provider Details

I. General information

NPI: 1275670549
Provider Name (Legal Business Name): COURTNEY LYLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 09/11/2025
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W 8TH AVE FL 3
SPOKANE WA
99204-2307
US

IV. Provider business mailing address

PO BOX 421
LIBERTY LAKE WA
99019-0421
US

V. Phone/Fax

Practice location:
  • Phone: 509-474-2777
  • Fax: 509-474-6222
Mailing address:
  • Phone: 866-747-2455
  • Fax: 509-227-7070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17181
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: