Provider Demographics
NPI:1063810711
Name:MCCOURT, KATRINA L (PMHNP-BC, FNP)
Entity type:Individual
Prefix:MS
First Name:KATRINA
Middle Name:L
Last Name:MCCOURT
Suffix:
Gender:F
Credentials:PMHNP-BC, FNP
Other - Prefix:MS
Other - First Name:KATRINA
Other - Middle Name:L
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3835 N FREEWAY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1954
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:916-277-9380
Practice Address - Street 1:2261 NASH ST NW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-1735
Practice Address - Country:US
Practice Address - Phone:252-237-8403
Practice Address - Fax:877-868-8991
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-11
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007364363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily