Provider Demographics
NPI:1275051831
Name:CORREA, COURTNEY CATHERINE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:CATHERINE
Last Name:CORREA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:COURTNEY
Other - Middle Name:CATHERINE
Other - Last Name:BRICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:10131 W MILITARY DR STE 104
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-1927
Mailing Address - Country:US
Mailing Address - Phone:210-899-1450
Mailing Address - Fax:210-899-1907
Practice Address - Street 1:10131 W MILITARY DR STE 104
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-1927
Practice Address - Country:US
Practice Address - Phone:210-899-1450
Practice Address - Fax:210-899-1907
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA11248363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX395599903OtherCSHCN
TX395599901Medicaid