Provider Demographics
NPI:1184378358
Name:CALKINS, COURTNEY LUSSIER (PA-C)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LUSSIER
Last Name:CALKINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:MICHELLE
Other - Last Name:LUSSIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1415 E 8TH ST STE 5
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-2663
Mailing Address - Country:US
Mailing Address - Phone:619-434-4288
Mailing Address - Fax:
Practice Address - Street 1:1415 E 8TH ST STE 5
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2663
Practice Address - Country:US
Practice Address - Phone:619-434-4288
Practice Address - Fax:619-434-4315
Is Sole Proprietor?:No
Enumeration Date:2022-02-07
Last Update Date:2024-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA60632363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical