Provider Demographics
NPI:1093493801
Name:WILCOX, KOURTNEY L (ARNP)
Entity Type:Individual
Prefix:
First Name:KOURTNEY
Middle Name:L
Last Name:WILCOX
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:IDA GROVE
Mailing Address - State:IA
Mailing Address - Zip Code:51445-1666
Mailing Address - Country:US
Mailing Address - Phone:712-364-3311
Mailing Address - Fax:712-364-3363
Practice Address - Street 1:701 E 2ND ST
Practice Address - Street 2:
Practice Address - City:IDA GROVE
Practice Address - State:IA
Practice Address - Zip Code:51445-1666
Practice Address - Country:US
Practice Address - Phone:712-364-3311
Practice Address - Fax:712-364-3363
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA174935363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner