Provider Demographics
NPI:1437392065
Name:FOLEY, COURTNEY (PA)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:FOLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4323 CAROTHERS PKWY STE 505
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-5920
Mailing Address - Country:US
Mailing Address - Phone:615-790-7992
Mailing Address - Fax:615-790-8688
Practice Address - Street 1:1106 ELLISTON WAY STE 101
Practice Address - Street 2:
Practice Address - City:THOMPSONS STATION
Practice Address - State:TN
Practice Address - Zip Code:37179-4408
Practice Address - Country:US
Practice Address - Phone:615-790-7992
Practice Address - Fax:615-790-8688
Is Sole Proprietor?:No
Enumeration Date:2009-04-13
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4063363A00000X
NC0010-02087363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8101047Medicaid
NC2762160Medicare PIN
NC8101047Medicaid