Provider Demographics
NPI:1346536505
Name:HESS, CORTNEY NICOLE (MD)
Entity Type:Individual
Prefix:
First Name:CORTNEY
Middle Name:NICOLE
Last Name:HESS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CORTNEY
Other - Middle Name:NICOLE
Other - Last Name:BOULTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 589
Mailing Address - Street 2:PETERSBURG MEDICAL CENTER
Mailing Address - City:PETERSBURG
Mailing Address - State:AK
Mailing Address - Zip Code:99833
Mailing Address - Country:US
Mailing Address - Phone:907-212-6522
Mailing Address - Fax:907-212-6593
Practice Address - Street 1:103 FRAM ST
Practice Address - Street 2:PETERSBURG MEDICAL CENTER
Practice Address - City:PETERSBURG
Practice Address - State:AK
Practice Address - Zip Code:99833
Practice Address - Country:US
Practice Address - Phone:907-772-4291
Practice Address - Fax:907-772-3085
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK6087207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD9638Medicaid