Provider Demographics
NPI:1194309799
Name:BIVINS, COURTNEY A (LPN)
Entity type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:A
Last Name:BIVINS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:301 ANDREWS AVENUE LYSTER ARMY HEALTH CLINIC
Mailing Address - Street 2:301 ANDREWS AVENUE LYSTER ARMY HEALTH CLINIC
Mailing Address - City:FORT RUCKER
Mailing Address - State:AL
Mailing Address - Zip Code:36362-5333
Mailing Address - Country:US
Mailing Address - Phone:334-255-7741
Mailing Address - Fax:
Practice Address - Street 1:301 ANDREWS AVENUE US ARMY AEROMEDICAL CENTER
Practice Address - Street 2:301 ANDREWS AVENUE US ARMY AEROMEDICAL CENTER
Practice Address - City:FORT RUCKER
Practice Address - State:AL
Practice Address - Zip Code:36362-5333
Practice Address - Country:US
Practice Address - Phone:334-255-7741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2-067657164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse