Provider Demographics
NPI:1467249854
Name:TRADER, COURTNY N
Entity type:Individual
Prefix:
First Name:COURTNY
Middle Name:N
Last Name:TRADER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2113 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT
Mailing Address - State:WV
Mailing Address - Zip Code:25550-1411
Mailing Address - Country:US
Mailing Address - Phone:304-771-6966
Mailing Address - Fax:
Practice Address - Street 1:66 FARMDALE RD
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-7501
Practice Address - Country:US
Practice Address - Phone:304-453-4992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant