Provider Demographics
NPI:1306193818
Name:COURTNEY, ANNE (NP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:COURTNEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 911230AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:2410 ROUND ROCK AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4003
Practice Address - Country:US
Practice Address - Phone:512-341-8724
Practice Address - Fax:512-687-0295
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22218363LA2100X
TX867930363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX342758501Medicaid
CA1306193818Medicaid
TX386717YKYCMedicare PIN
CA1306193818Medicaid