Provider Demographics
NPI:1336158245
Name:HENLEY, COURTNEY NASH (MD)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:NASH
Last Name:HENLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 NORTH CENTER ST #800
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7406
Mailing Address - Country:US
Mailing Address - Phone:801-990-1911
Mailing Address - Fax:801-990-1912
Practice Address - Street 1:8TH AVENUE AND C STREET
Practice Address - Street 2:LDS HOSPITAL
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84143
Practice Address - Country:US
Practice Address - Phone:801-507-5248
Practice Address - Fax:801-733-5618
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4850304-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT91145OtherHEALTHY U
ID806689900Medicaid
WY118873900Medicaid
UT75171OtherPEHP
UT870545614HE2OtherEDUCATORS MUTUAL
UT107018655102OtherIHC
UT808698OtherDESERET MUTUAL
AZ820250Medicaid
UT48503041201001OtherREGENCE BCBS
UT1502954OtherUMWA
UTQM0000075886OtherALTIUS
UTTPRA07550OtherMOLINA
NV100503352Medicaid
UT2090168OtherUNITED HEALTHCARE
UT870545614HE2OtherEDUCATORS MUTUAL
UT107018655102OtherIHC
UTP00203091Medicare ID - Type UnspecifiedRAILROAD MEDICARE