Provider Demographics
NPI:1154976660
Name:MYERS, COURTNEY KAY (PA-C)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:KAY
Last Name:MYERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2129
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79760-2129
Mailing Address - Country:US
Mailing Address - Phone:432-337-3117
Mailing Address - Fax:432-640-6366
Practice Address - Street 1:540 W 5TH ST STE 460
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5068
Practice Address - Country:US
Practice Address - Phone:432-337-3117
Practice Address - Fax:432-640-6366
Is Sole Proprietor?:No
Enumeration Date:2019-08-02
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA14083363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX419221301Medicaid