MEDICARE: COURTNEY ANN BEVILLE-MATTINA

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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1922849207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY ANN BEVILLE-MATTINA

Provider Business Mailing Address
First Line	:	8101 RUE HOLLIFIELD
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-7567
Country	:	US
Telephone Number	:	228-327-2609
Fax Number	:

Provider Business Practice Location Address
First Line	:	8101 RUE HOLLIFIELD
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-7567
Country	:	US
Telephone Number	:	228-327-2609
Fax Number	:

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

Provider Enumeration Date	:	06/03/2024
Last Update Date	:	06/03/2024

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Directions to “ COURTNEY ANN BEVILLE-MATTINA ” Practice Location

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