Provider Demographics
NPI:1144662628
Name:BEAN, COURTNEY EVELYN (LPN)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:EVELYN
Last Name:BEAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 BELL RIDGE RD
Mailing Address - Street 2:#502
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-8014
Mailing Address - Country:US
Mailing Address - Phone:423-647-7105
Mailing Address - Fax:
Practice Address - Street 1:1319 BELL RIDGE RD
Practice Address - Street 2:#502
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-8014
Practice Address - Country:US
Practice Address - Phone:423-647-7105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN79445164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse