Provider Demographics
NPI:1962032888
Name:EBERHARD, COURTNEY BLAIR
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:BLAIR
Last Name:EBERHARD
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 1:2255 STURGIS RD
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-8029
Mailing Address - Country:US
Mailing Address - Phone:501-205-0011
Mailing Address - Fax:
Practice Address - Street 1:2255 STURGIS RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-8029
Practice Address - Country:US
Practice Address - Phone:501-205-0011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-20
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR123616363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health