Provider Demographics
NPI:1861935686
Name:ARCHIE, COURTNEY (CRNA)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:ARCHIE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 RICHLAND DR W
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-6332
Mailing Address - Country:US
Mailing Address - Phone:225-328-2425
Mailing Address - Fax:
Practice Address - Street 1:1700 LINDBERG DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-8062
Practice Address - Country:US
Practice Address - Phone:985-661-2151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-28
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11026167367500000X
LAAP09067367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered