Provider Demographics
NPI:1760563233
Name:DUNAVANT, COURTNEY WELLS (PA)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:WELLS
Last Name:DUNAVANT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 HATLEY DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-4608
Mailing Address - Country:US
Mailing Address - Phone:917-561-0828
Mailing Address - Fax:
Practice Address - Street 1:405 N LAMAR BLVD # 110
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-2103
Practice Address - Country:US
Practice Address - Phone:737-255-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX08618363AS0400X, 363AS0400X
GA4906363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical