Healthcare Provider Details

I. General information

NPI: 1174058820
Provider Name (Legal Business Name): KOURTNIE ROXANNE MCQUILLEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. KOURTNIE ROXANNE BROWN

II. Dates (important events)

Enumeration Date: 05/01/2017
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 HOSPITAL PLZ STE 103
WESTON WV
26452-8595
US

IV. Provider business mailing address

66 HOSPITAL PLZ STE 103
WESTON WV
26452-8595
US

V. Phone/Fax

Practice location:
  • Phone: 304-269-3108
  • Fax:
Mailing address:
  • Phone: 304-269-3108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number29149
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: