Provider Demographics
NPI:1356688287
Name:DRYDEN, COURTNEY RAE (PA-C)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:RAE
Last Name:DRYDEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3953 CANDLENUT LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-6607
Mailing Address - Country:US
Mailing Address - Phone:214-646-2668
Mailing Address - Fax:214-645-2661
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7201
Practice Address - Country:US
Practice Address - Phone:214-646-2668
Practice Address - Fax:214-645-2661
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363AM0700X
TXPA08213363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical