Provider Demographics
NPI:1265630701
Name:CABELL, CORTNEY HEATHER-ANNICE (MD)
Entity Type:Individual
Prefix:MS
First Name:CORTNEY
Middle Name:HEATHER-ANNICE
Last Name:CABELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 NORTHCREST DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37172-4066
Mailing Address - Country:US
Mailing Address - Phone:615-219-6190
Mailing Address - Fax:
Practice Address - Street 1:500 NORTHCREST DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-4066
Practice Address - Country:US
Practice Address - Phone:615-219-6190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN45067207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1524679Medicaid
DEMD5304OtherSTATE NARCOTICS CERTFICAT
TN1524679Medicaid
TN45067OtherMEDICAL LICENSE
DE162440OtherMEDICARE GROUP NUMBER
DE1265630701Medicaid
TN103I167728Medicare PIN
DE162440OtherMEDICARE GROUP NUMBER