Provider Demographics
NPI:1912371683
Name:BECKNER, COURTNEY BROOKS (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:BROOKS
Last Name:BECKNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:COURTNEY
Other - Middle Name:PAIGE
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:513 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:TAZEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:24651-9616
Mailing Address - Country:US
Mailing Address - Phone:276-979-5947
Mailing Address - Fax:
Practice Address - Street 1:513 ORANGE ST
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:VA
Practice Address - Zip Code:24651-9616
Practice Address - Country:US
Practice Address - Phone:276-979-5947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-18
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110005145363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical