Provider Demographics
NPI:1700148053
Name:HOUSER, KOURTNEY HENDERSON (MD)
Entity Type:Individual
Prefix:DR
First Name:KOURTNEY
Middle Name:HENDERSON
Last Name:HOUSER
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:HAMILTON EYE INSTITUTE 930 MADISON AVENUE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-3452
Mailing Address - Country:US
Mailing Address - Phone:901-448-6650
Mailing Address - Fax:
Practice Address - Street 1:930 MADISON AVE STE 200
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103
Practice Address - Country:US
Practice Address - Phone:901-448-6650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ7558207W00000X
TN55739207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR222061001Medicaid
MO1700148053Medicaid
MS09775353Medicaid
TNQ029795Medicaid