Provider Demographics
NPI:1184206567
Name:DELONG, COURTNEY K
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:K
Last Name:DELONG
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 1:12200 W 106TH ST STE 325
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2381
Mailing Address - Country:US
Mailing Address - Phone:913-541-6072
Mailing Address - Fax:
Practice Address - Street 1:12200 W 106TH ST STE 325
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-2381
Practice Address - Country:US
Practice Address - Phone:913-541-6072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-25
Last Update Date:2023-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program