Provider Demographics
NPI:1275218307
Name:QUALLS, COURTNEY (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:
Last Name:QUALLS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9329 COUNTY ROAD 2290
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:AL
Mailing Address - Zip Code:36035-2419
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1758 PARK PL STE 401
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1135
Practice Address - Country:US
Practice Address - Phone:334-293-9191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-16
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-152469363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner