Provider Demographics
NPI:1821576638
Name:VALLERY, COURTNEY ANN CONTRERAS (PA)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ANN CONTRERAS
Last Name:VALLERY
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 1:5171 S CUB LAKE RD STE C350
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-7820
Mailing Address - Country:US
Mailing Address - Phone:928-537-8285
Mailing Address - Fax:928-537-8291
Practice Address - Street 1:5171 S CUB LAKE RD STE C350
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7820
Practice Address - Country:US
Practice Address - Phone:928-537-8285
Practice Address - Fax:928-537-8291
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical