Provider Demographics
NPI:1508452863
Name:COURTNEY, LAUREN PRINCE (PA-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:PRINCE
Last Name:COURTNEY
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 1:100 HEALTHY WAY STE 1260
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-7918
Mailing Address - Country:US
Mailing Address - Phone:864-225-3551
Mailing Address - Fax:864-328-0328
Practice Address - Street 1:100 HEALTHY WAY STE 1260
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-7918
Practice Address - Country:US
Practice Address - Phone:864-225-3551
Practice Address - Fax:864-328-0328
Is Sole Proprietor?:No
Enumeration Date:2020-12-21
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4316363A00000X
SCPA3789363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant