Provider Demographics
NPI:1508458720
Name:TRAVERSE, COURTENAY (NP)
Entity Type:Individual
Prefix:
First Name:COURTENAY
Middle Name:
Last Name:TRAVERSE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312 CREEK CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:TX
Mailing Address - Zip Code:76210-3607
Mailing Address - Country:US
Mailing Address - Phone:940-765-0257
Mailing Address - Fax:
Practice Address - Street 1:2813 S MAYHILL RD
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76208-5910
Practice Address - Country:US
Practice Address - Phone:940-565-8580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX903714163WM0705X
TX1030888363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical