Healthcare Provider Details

I. General information

NPI: 1275035107
Provider Name (Legal Business Name): COURTNEY LAYTON AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2018
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 MORGANTOWN ST
KINGWOOD WV
26537-1140
US

IV. Provider business mailing address

150 MEMORIAL DR
KINGWOOD WV
26537-1141
US

V. Phone/Fax

Practice location:
  • Phone: 304-329-0256
  • Fax: 304-329-0733
Mailing address:
  • Phone: 304-329-1400
  • Fax: 304-329-1175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN78934NP
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: