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NPI Code Detail

MEDICARE: MS. KATRINA L MCCOURT PMHNP-BC, FNP

MEDICARE: MS. KATRINA L MCCOURT PMHNP-BC, FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner5007364NC
2363LF0000XFamily Nurse Practitioner5007364NC

General Provider Information

NPI Number : 1063810711
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KATRINA L MCCOURT PMHNP-BC, FNP
Provider Business Mailing Address
First Line : 3835 N FREEWAY BLVD STE 100
Second Line :
City : SACRAMENTO
State : CA
Zip : 95834-1954
Country : US
Telephone Number :
Fax Number : 916-277-9380
Provider Business Practice Location Address
First Line : 2261 NASH ST NW
Second Line :
City : WILSON
State : NC
Zip : 27896-1735
Country : US
Telephone Number : 252-237-8403
Fax Number : 877-868-8991
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/11/2014
Last Update Date : 08/06/2024

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