Provider Demographics
NPI:1770040941
Name:WRIGHT, COURTNEY CHLOE
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:CHLOE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 COUNTY ROAD 831
Mailing Address - Street 2:
Mailing Address - City:BOAZ
Mailing Address - State:AL
Mailing Address - Zip Code:35957-7769
Mailing Address - Country:US
Mailing Address - Phone:256-659-8381
Mailing Address - Fax:
Practice Address - Street 1:1180 SARDIS DR
Practice Address - Street 2:
Practice Address - City:BOAZ
Practice Address - State:AL
Practice Address - Zip Code:35956-2139
Practice Address - Country:US
Practice Address - Phone:256-593-9999
Practice Address - Fax:256-593-9141
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-138745363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health