Provider Demographics
NPI:1831795475
Name:MULROY, COURTNEY ANN
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ANN
Last Name:MULROY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 SCRABBLETOWN RD STE A
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-3638
Mailing Address - Country:US
Mailing Address - Phone:401-408-9235
Mailing Address - Fax:
Practice Address - Street 1:1170 PONTIAC AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-7944
Practice Address - Country:US
Practice Address - Phone:401-837-9937
Practice Address - Fax:401-296-3995
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN64647163W00000X
MARN2301482163W00000X
RIAPRN03328363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse