Provider Demographics
NPI:1851960215
Name:WATERS, COURTNEY IVA (FNP-C)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:IVA
Last Name:WATERS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3445 COLEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:THOMPSONS STATION
Mailing Address - State:TN
Mailing Address - Zip Code:37179-9612
Mailing Address - Country:US
Mailing Address - Phone:615-260-7414
Mailing Address - Fax:
Practice Address - Street 1:3445 COLEBROOK DR
Practice Address - Street 2:
Practice Address - City:THOMPSONS STATION
Practice Address - State:TN
Practice Address - Zip Code:37179-9612
Practice Address - Country:US
Practice Address - Phone:615-260-7414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28713363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily