Provider Demographics
NPI:1972258671
Name:PARKER, COURTNEY L (NP)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:L
Last Name:PARKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 W IRONWOOD DR # 1030
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2640
Mailing Address - Country:US
Mailing Address - Phone:509-361-5154
Mailing Address - Fax:
Practice Address - Street 1:2851 N WHITE PINES DR
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-6259
Practice Address - Country:US
Practice Address - Phone:702-443-2442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-21
Last Update Date:2023-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10013293363LP0808X
ID73849363LP0808X
WAAP61350441363LP0808X
OR202003184RN163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP61350441OtherWA APRN
ID73849OtherID APRN
ID73849OtherID APRN
WAMP7614440OtherWA DEA