Provider Demographics
NPI:1194432005
Name:MCCARTY, COURTNEY (CPNP-PC)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:MCCARTY
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 BRADFORD LN
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298-3369
Mailing Address - Country:US
Mailing Address - Phone:618-939-0112
Mailing Address - Fax:618-939-0119
Practice Address - Street 1:224 BRADFORD LN
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IL
Practice Address - Zip Code:62298-3369
Practice Address - Country:US
Practice Address - Phone:618-939-0112
Practice Address - Fax:618-939-0119
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209026307363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics