Provider Demographics
NPI:1780074518
Name:TRIPLETT, COURTNEY R (RN)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:R
Last Name:TRIPLETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 WATER ST STE 435
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39530-4220
Mailing Address - Country:US
Mailing Address - Phone:228-355-2735
Mailing Address - Fax:
Practice Address - Street 1:770 WATER ST STE 435
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39530-4220
Practice Address - Country:US
Practice Address - Phone:228-355-2735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-02
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS915770163WC1600X, 163WD0400X, 163WM0705X, 163W00000X
WI319080-31164W00000X
372600000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI47-3062390OtherEIN