Provider Demographics
NPI:1609481985
Name:COURTNEY, CARLY (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:CARLY
Middle Name:
Last Name:COURTNEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28010 COMAL KARST DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-3926
Mailing Address - Country:US
Mailing Address - Phone:432-556-6875
Mailing Address - Fax:
Practice Address - Street 1:3592 HARMONY COMMONS DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-4894
Practice Address - Country:US
Practice Address - Phone:281-419-1177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-13
Last Update Date:2020-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1011817363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily