Provider Demographics
NPI:1093242190
Name:MARTIN, COURTNEY MARIE
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:MARIE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 DR NEWBERN RD
Mailing Address - Street 2:
Mailing Address - City:POWELLS POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27966-9732
Mailing Address - Country:US
Mailing Address - Phone:252-267-1739
Mailing Address - Fax:
Practice Address - Street 1:717 OLD FARM RD S
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-5032
Practice Address - Country:US
Practice Address - Phone:252-536-5440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-19
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer