Provider Demographics
NPI:1598203143
Name:POLK, COURTNEY LOMAX (RN)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LOMAX
Last Name:POLK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7909 SAINT FILLANS LN
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089-7860
Mailing Address - Country:US
Mailing Address - Phone:214-814-4586
Mailing Address - Fax:
Practice Address - Street 1:7909 SAINT FILLANS LN
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75089-7860
Practice Address - Country:US
Practice Address - Phone:214-814-4586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-03
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX765510163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant