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NPI Code Detail

MEDICARE: MRS. COURTNEY NIKOLE COUTURE PA-C

MEDICARE: MRS. COURTNEY NIKOLE COUTURE 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
1363A00000XPhysician AssistantPA.1032AL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1952702722
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. COURTNEY NIKOLE COUTURE PA-C
Provider Business Mailing Address
First Line : PO BOX 729
Second Line :
City : DOTHAN
State : AL
Zip : 36302-0729
Country : US
Telephone Number : 334-793-2663
Fax Number : 334-836-2248
Provider Business Practice Location Address
First Line : 4300 W MAIN ST STE 405
Second Line :
City : DOTHAN
State : AL
Zip : 36305-1086
Country : US
Telephone Number : 334-944-7073
Fax Number : 334-944-7058
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2014
Last Update Date : 11/23/2022

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