Provider Demographics
NPI:1073074258
Name:CLUBB, COURTNEY (MSN-FNP)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:CLUBB
Suffix:
Gender:F
Credentials:MSN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3016 WOODRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-5232
Mailing Address - Country:US
Mailing Address - Phone:806-543-7339
Mailing Address - Fax:
Practice Address - Street 1:410 N HANCOCK AVE # 4
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5140
Practice Address - Country:US
Practice Address - Phone:432-279-0905
Practice Address - Fax:432-279-0904
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141065363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily