Provider Demographics
NPI:1326419292
Name:AUGUSTYN, KOURTNEY ELIZABETH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KOURTNEY
Middle Name:ELIZABETH
Last Name:AUGUSTYN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KOURTNEY
Other - Middle Name:ELIZABETH
Other - Last Name:HOLBROOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:535 BARNHILL DR STE 200
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5116
Practice Address - Country:US
Practice Address - Phone:317-278-7418
Practice Address - Fax:317-278-7418
Is Sole Proprietor?:No
Enumeration Date:2015-10-16
Last Update Date:2021-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10348363A00000X
IN10003248A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX357488105Medicaid
TX357488106Medicaid
TX8JH997OtherBCBS