Provider Demographics
NPI:1164406567
Name:MOBERLEY, COURTNEY F (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:F
Last Name:MOBERLEY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 JOHNSON ST STE A
Mailing Address - Street 2:
Mailing Address - City:TALLULAH
Mailing Address - State:LA
Mailing Address - Zip Code:71282-4537
Mailing Address - Country:US
Mailing Address - Phone:318-574-5080
Mailing Address - Fax:318-574-5052
Practice Address - Street 1:900 JOHNSON ST STE A
Practice Address - Street 2:
Practice Address - City:TALLULAH
Practice Address - State:LA
Practice Address - Zip Code:71282-4537
Practice Address - Country:US
Practice Address - Phone:318-574-5080
Practice Address - Fax:318-574-5052
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04825363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1722227Medicaid
LAQ57446Medicare UPIN
LA4H703Medicare PIN