Provider Demographics
NPI:1144600164
Name:CARROUTH, COURTNEY EVANS (NP-C)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:EVANS
Last Name:CARROUTH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:BLAKE
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:916 CHESAPEAKE PL
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-6243
Mailing Address - Country:US
Mailing Address - Phone:252-717-3394
Mailing Address - Fax:
Practice Address - Street 1:850 WH SMITH BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3763
Practice Address - Country:US
Practice Address - Phone:252-758-3211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC253101363LF0000X
NC5007667363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily