MEDICARE: COURTNEY CHLOE WRIGHT

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	363LA2200X	Adult Health Nurse Practitioner	1-138745	AL

General Provider Information

NPI Number	:	1770040941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY CHLOE WRIGHT

Provider Business Mailing Address
First Line	:	134 COUNTY ROAD 831
Second Line	:
City	:	BOAZ
State	:	AL
Zip	:	35957-7769
Country	:	US
Telephone Number	:	256-659-8381
Fax Number	:

Provider Business Practice Location Address
First Line	:	1180 SARDIS DR
Second Line	:
City	:	BOAZ
State	:	AL
Zip	:	35956-2139
Country	:	US
Telephone Number	:	256-593-9999
Fax Number	:	256-593-9141

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

Provider Enumeration Date	:	02/25/2019
Last Update Date	:	02/25/2019

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Directions to “ COURTNEY CHLOE WRIGHT ” Practice Location

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