Provider Demographics
NPI:1356931646
Name:BAGLEY, COURTNEY LYNN (MSN-FNP)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LYNN
Last Name:BAGLEY
Suffix:
Gender:F
Credentials:MSN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 STAR DUST
Mailing Address - Street 2:
Mailing Address - City:CRAWFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76638-3276
Mailing Address - Country:US
Mailing Address - Phone:254-709-7044
Mailing Address - Fax:
Practice Address - Street 1:202 E JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:WHITNEY
Practice Address - State:TX
Practice Address - Zip Code:76692-2398
Practice Address - Country:US
Practice Address - Phone:254-694-2221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX761988363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily