=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699148460
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | COURTNEY RAE HAMBY MSN, FNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2015
-----------------------------------------------------
Last Update Date | 03/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3008 POLAR LN STE 101
-----------------------------------------------------
City | CEDAR PARK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78613-1914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-924-4923
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3008 POLAR LN STE 101
-----------------------------------------------------
City | CEDAR PARK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78613-1914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-924-4923
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 1131977
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------