Provider Demographics
NPI:1336838390
Name:DEWITT, COURTNI LEE (NP)
Entity Type:Individual
Prefix:MRS
First Name:COURTNI
Middle Name:LEE
Last Name:DEWITT
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 1:739 SYPOLT RUN
Mailing Address - Street 2:
Mailing Address - City:ALBRIGHT
Mailing Address - State:WV
Mailing Address - Zip Code:26519-7266
Mailing Address - Country:US
Mailing Address - Phone:304-288-4376
Mailing Address - Fax:
Practice Address - Street 1:150 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:WV
Practice Address - Zip Code:26537-1141
Practice Address - Country:US
Practice Address - Phone:304-288-4376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV104391363LF0000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse