Provider Demographics
NPI:1497372734
Name:KUMAR, COURTNEY HANNON (PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:HANNON
Last Name:KUMAR
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:SLADE
Other - Last Name:HANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:221 STONEBRIDGE PLAZA AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-6972
Mailing Address - Country:US
Mailing Address - Phone:804-378-6141
Mailing Address - Fax:
Practice Address - Street 1:221 STONEBRIDGE PLAZA AVE # ACE
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23225-6972
Practice Address - Country:US
Practice Address - Phone:804-378-6141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-02
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024179610363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health