Provider Demographics
NPI:1831183334
Name:MCFARLIN, COURTNEY M (PA)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:M
Last Name:MCFARLIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:M
Other - Last Name:WHIPPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2129 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-6666
Mailing Address - Country:US
Mailing Address - Phone:618-257-2029
Mailing Address - Fax:618-235-5371
Practice Address - Street 1:2129 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-6666
Practice Address - Country:US
Practice Address - Phone:618-257-2029
Practice Address - Fax:618-235-5371
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085001714363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
212557Medicare PIN
Q06615Medicare UPIN
IL212529004Medicare PIN
K29420Medicare PIN