Provider Demographics
NPI:1841560034
Name:HERNANDEZ, COURTNEY M (PA-C)
Entity Type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:M
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1009 S SERVICE RD W
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-2364
Mailing Address - Country:US
Mailing Address - Phone:318-242-1440
Mailing Address - Fax:318-242-1465
Practice Address - Street 1:1009 S SERVICE RD W
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-2364
Practice Address - Country:US
Practice Address - Phone:318-242-1440
Practice Address - Fax:318-242-1465
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAPA200508363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical