Provider Demographics
NPI:1326806498
Name:GREEN, COURTNIE JOE (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:COURTNIE
Middle Name:JOE
Last Name:GREEN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:962 ROCK CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ESTILL SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37330-3414
Mailing Address - Country:US
Mailing Address - Phone:931-581-1102
Mailing Address - Fax:
Practice Address - Street 1:2034 EDISON PARK LN
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-2685
Practice Address - Country:US
Practice Address - Phone:931-581-1102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35846363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily