Provider Demographics
NPI:1538444641
Name:WILLOUGHBY, COURTNEY LEE (MSN, WHNP)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LEE
Last Name:WILLOUGHBY
Suffix:
Gender:F
Credentials:MSN, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1602
Mailing Address - Country:US
Mailing Address - Phone:205-510-3408
Mailing Address - Fax:
Practice Address - Street 1:1500 6TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1602
Practice Address - Country:US
Practice Address - Phone:205-934-2170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-109552363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL133099Medicaid
ALZ50030OtherVIVA
AL051121518OtherBCBS
AL051121519OtherBCBS
AL051121528OtherBCBS
AL133089Medicaid
AL133105Medicaid
AL133120Medicaid
AL051121517OtherBCBS
AL133100Medicaid
AL051121523OtherBCBS
AL051121524OtherBCBS
AL133114Medicaid
MS03876091Medicaid
AL051121520OtherBCBS
AL051121529OtherBCBS
AL133115Medicaid
AL051121527OtherBCBS
AL133103Medicaid
AL133107Medicaid
AL051121526OtherBCBS
AL133106Medicaid
AL133100Medicaid