Provider Demographics
NPI:1851869812
Name:CRAIG, COURTNEY (FNP)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:CRAIG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:147 W GREEN MEADOWS DR STE 2
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-4000
Mailing Address - Country:US
Mailing Address - Phone:812-200-2789
Mailing Address - Fax:
Practice Address - Street 1:147 W GREEN MEADOWS DR STE 2
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-4000
Practice Address - Country:US
Practice Address - Phone:812-200-2789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71008527A363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300020940Medicaid