Provider Demographics
NPI:1306299532
Name:SCOTT, COURTNEY SIMMONS (MMS, PA-C)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:SIMMONS
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:SHAYE
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PROVIDER ENROLLMENT
Mailing Address - Street 2:100 KIMEL FOREST DRIVE
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6074
Mailing Address - Country:US
Mailing Address - Phone:336-713-0947
Mailing Address - Fax:
Practice Address - Street 1:1038 BETHANIA RURAL HALL RD
Practice Address - Street 2:
Practice Address - City:RURAL HALL
Practice Address - State:NC
Practice Address - Zip Code:27045-9552
Practice Address - Country:US
Practice Address - Phone:336-716-9270
Practice Address - Fax:336-702-9313
Is Sole Proprietor?:No
Enumeration Date:2016-07-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-06616363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant