Provider Demographics
NPI:1013142876
Name:COURTNEY, ERICA LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:LYNN
Last Name:COURTNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ERICA
Other - Middle Name:LYNN
Other - Last Name:GILLETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6675 HOLMES RD
Mailing Address - Street 2:STE 360
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-1150
Mailing Address - Country:US
Mailing Address - Phone:816-276-7600
Mailing Address - Fax:816-276-7992
Practice Address - Street 1:1325 N RACE ST
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-3427
Practice Address - Country:US
Practice Address - Phone:270-651-4797
Practice Address - Fax:270-651-4818
Is Sole Proprietor?:No
Enumeration Date:2009-05-22
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012035755207Q00000X
390200000X
KY53005207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100627440Medicaid
KYK308771OtherMEDICARE
KYK308770OtherMEDICARE