Provider Demographics
NPI:1407000920
Name:NOON, COURTNEY WIGREN (PA)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:WIGREN
Last Name:NOON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:LAURA
Other - Last Name:WIGREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1401 3RD AVE N APT 127
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37208-3271
Mailing Address - Country:US
Mailing Address - Phone:912-604-7770
Mailing Address - Fax:
Practice Address - Street 1:2011 MURPHY AVE STE 400
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2065
Practice Address - Country:US
Practice Address - Phone:954-533-2350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-11
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4886363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4886OtherTN STATE LICENSE