Provider Demographics
NPI:1164977781
Name:CALKINS, COURTNEY LIN (PA)
Entity Type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:LIN
Last Name:CALKINS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4052 LEGACY PKWY
Mailing Address - Street 2:STE 200
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4285
Mailing Address - Country:US
Mailing Address - Phone:517-272-9700
Mailing Address - Fax:
Practice Address - Street 1:4052 LEGACY PKWY
Practice Address - Street 2:STE 200
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4285
Practice Address - Country:US
Practice Address - Phone:517-272-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-24
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
MI5601010065363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner