Provider Demographics
NPI:1548568926
Name:WHITTEN, COURTNEY KAY
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:KAY
Last Name:WHITTEN
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 1:1101 WILLIS AVE
Mailing Address - Street 2:APT #1
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-1034
Mailing Address - Country:US
Mailing Address - Phone:704-713-2596
Mailing Address - Fax:
Practice Address - Street 1:1101 WILLIS AVE
Practice Address - Street 2:APT #1
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-1034
Practice Address - Country:US
Practice Address - Phone:704-713-2596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-08
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC193041163W00000X, 163WG0000X, 163WM0705X, 163WP0200X, 163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care