=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851960215
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | COURTNEY IVA WATERS FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2021
-----------------------------------------------------
Last Update Date | 12/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3445 COLEBROOK DR
-----------------------------------------------------
City | THOMPSONS STATION
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37179-9612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-260-7414
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3445 COLEBROOK DR
-----------------------------------------------------
City | THOMPSONS STATION
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37179-9612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-260-7414
-----------------------------------------------------
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 | 29713
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------