Provider Demographics
NPI:1548722986
Name:HAYES, COURTNEY BROOKE STREETS (NP-C)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:BROOKE STREETS
Last Name:HAYES
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:BROOKE
Other - Last Name:STREETS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 724
Mailing Address - Street 2:
Mailing Address - City:MASONTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26542-0724
Mailing Address - Country:US
Mailing Address - Phone:304-642-7061
Mailing Address - Fax:
Practice Address - Street 1:12302 VETERANS MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:REEDSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26547-6501
Practice Address - Country:US
Practice Address - Phone:304-980-2006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV78325363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily