Provider Demographics
NPI:1477005122
Name:MATHIS, COURTNEY RACQUEL (MSN, ARNP, WHNP-BC)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:RACQUEL
Last Name:MATHIS
Suffix:
Gender:F
Credentials:MSN, ARNP, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1040 RIVER OAKS DR STE 103
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9531
Mailing Address - Country:US
Mailing Address - Phone:601-948-6540
Mailing Address - Fax:
Practice Address - Street 1:1040 RIVER OAKS DR STE 103
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9531
Practice Address - Country:US
Practice Address - Phone:601-948-6540
Practice Address - Fax:601-948-6518
Is Sole Proprietor?:No
Enumeration Date:2016-10-28
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS903706363LX0001X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology