Provider Demographics
NPI:1750513024
Name:TENNENT, COURTNEY R (APN)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:R
Last Name:TENNENT
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 N HILLCREST
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75482-2091
Mailing Address - Country:US
Mailing Address - Phone:903-438-1110
Mailing Address - Fax:903-438-1107
Practice Address - Street 1:1317 N HILLCREST
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-2091
Practice Address - Country:US
Practice Address - Phone:903-438-1110
Practice Address - Fax:903-438-1107
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-19
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR77367363L00000X
TX800060363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner