Provider Demographics
NPI:1568021822
Name:STELLOS, COURTNEY CARLISLE (CRNP)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:CARLISLE
Last Name:STELLOS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:PAIGE
Other - Last Name:CARLISLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 5430
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36205
Mailing Address - Country:US
Mailing Address - Phone:256-241-6310
Mailing Address - Fax:256-238-0555
Practice Address - Street 1:171 TOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36205
Practice Address - Country:US
Practice Address - Phone:256-237-1625
Practice Address - Fax:256-241-5400
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-144810363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily