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General NPI Number Information
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NPI Number | 1356931646
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Entity Type | Individual
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Provider Name | COURTNEY LYNN BAGLEY MSN-FNP
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Gender | Female
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Dates
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Enumeration Date | 01/21/2021
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Last Update Date | 01/21/2021
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Provider Practice Location Address
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Address Line | 202 E JEFFERSON AVE
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City | WHITNEY
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State | TX
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Zip | 76692-2398
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Country | US
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Telephone | 254-694-2221
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Fax |
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Provider Business Mailing Address
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Address Line | 965 STAR DUST
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City | CRAWFORD
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State | TX
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Zip | 76638-3276
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Country | US
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Telephone | 254-709-7044
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 761988
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License Number State | TX
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