MEDICARE: MRS. COURTNEY HOVESTADT 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	363AM0700X	Medical Physician Assistant	0010-15148	NC

General Provider Information

NPI Number	:	1760147599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. COURTNEY HOVESTADT PA-C

Provider Business Mailing Address
First Line	:	109 W SHEPHERD RIDGE LN APT 207
Second Line	:
City	:	MOORESVILLE
State	:	NC
Zip	:	28117-7158
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	409 OLIN WAY STE 1200
Second Line	:
City	:	DENVER
State	:	NC
Zip	:	28037-9250
Country	:	US
Telephone Number	:	704-801-7320
Fax Number	:

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

Provider Enumeration Date	:	11/06/2021
Last Update Date	:	03/13/2025

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