Provider Demographics
NPI:1245425701
Name:RIDER, COURTNEY ELIZABETH (PA-C)
Entity Type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:ELIZABETH
Last Name:RIDER
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1601 RIO GRANDE ST
Mailing Address - Street 2:SUITE 340
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-1137
Mailing Address - Country:US
Mailing Address - Phone:512-324-8960
Mailing Address - Fax:512-324-8962
Practice Address - Street 1:1301 W 38TH ST
Practice Address - Street 2:SUITE 514
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1000
Practice Address - Country:US
Practice Address - Phone:512-681-0500
Practice Address - Fax:512-681-0501
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2012-11-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA05208363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX211232802Medicaid
TX831N41OtherBCBS
TX211232803Medicaid
TX211232803Medicaid
TX211232802Medicaid