Provider Demographics
NPI:1295071322
Name:COURTNEY BICKERSTAFF APN,PLLC
Entity type:Organization
Organization Name:COURTNEY BICKERSTAFF APN,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APN
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:CAMILLE
Authorized Official - Last Name:BICKERSTAFF
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:501-909-1153
Mailing Address - Street 1:1309 ASHLEA PLACE DR
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-9159
Mailing Address - Country:US
Mailing Address - Phone:501-909-1153
Mailing Address - Fax:
Practice Address - Street 1:1309 ASHLEA PLACE DR
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-9159
Practice Address - Country:US
Practice Address - Phone:501-909-1153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03082313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility