Provider Demographics
NPI:1669049482
Name:HAMILTON, COURTNEY A (RN, WCC, CRRN)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:A
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:RN, WCC, CRRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 CELIA LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2203
Mailing Address - Country:US
Mailing Address - Phone:859-230-3469
Mailing Address - Fax:
Practice Address - Street 1:2710 MAN O WAR BLVD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515-3801
Practice Address - Country:US
Practice Address - Phone:859-273-0088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1093395364SL0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SL0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistLong-Term Care