Provider Demographics
NPI:1669688925
Name:MCCOURT, CARLA (CRNP)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:MCCOURT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:891 EAST BALTIMORE PIKE
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348
Mailing Address - Country:US
Mailing Address - Phone:610-444-0113
Mailing Address - Fax:610-444-0744
Practice Address - Street 1:891 EAST BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348
Practice Address - Country:US
Practice Address - Phone:610-444-0113
Practice Address - Fax:610-444-0744
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP006184D363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA002728OtherPRESCRIPTION AUTH
PA98101OtherNURSE CERTIFICATION
PARN333161LOtherRN LICENSE
PATP006184DOtherCRNP LICENSE