Provider Demographics
NPI:1417111246
Name:GOTTSCHALL, COURTNEY GINETTE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:GINETTE
Last Name:GOTTSCHALL
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:PO BOX 681789
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-1789
Mailing Address - Country:US
Mailing Address - Phone:615-230-3045
Mailing Address - Fax:
Practice Address - Street 1:179 HANCOCK ST
Practice Address - Street 2:SUITE 203
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-6346
Practice Address - Country:US
Practice Address - Phone:615-230-3045
Practice Address - Fax:615-230-3047
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN000001577363AM0700X
TN1577363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1524458Medicaid
TN1524458Medicaid