Provider Demographics
NPI:1932981610
Name:REID, COURTNEY VIOLA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:VIOLA
Last Name:REID
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15813 PAUL VEGA MD DR STE 300
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-1431
Mailing Address - Country:US
Mailing Address - Phone:985-230-7675
Mailing Address - Fax:985-230-7676
Practice Address - Street 1:15813 PAUL VEGA MD DR STE 300
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1431
Practice Address - Country:US
Practice Address - Phone:985-230-7675
Practice Address - Fax:985-230-7676
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200487363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty