MEDICARE: COURTNEY RAE MCDERMOTT PA-C

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
1	363A00000X	Physician Assistant	PA2201	NV

General Provider Information

NPI Number	:	1235771197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY RAE MCDERMOTT PA-C

Provider Business Mailing Address
First Line	:	PO BOX 80895
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89180-0895
Country	:	US
Telephone Number	:	702-508-9119
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 N GREEN VALLEY PKWY STE 7B
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-5889
Country	:	US
Telephone Number	:	702-508-9119
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2019
Last Update Date	:	03/23/2025

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