Provider Demographics
NPI:1306320452
Name:ROCKETT, COURTNEY MICHELLE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:MICHELLE
Last Name:ROCKETT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:COURTNEY
Other - Middle Name:MICHELLE
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:9291 MEDICAL PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9126
Mailing Address - Country:US
Mailing Address - Phone:843-764-1730
Mailing Address - Fax:843-764-1731
Practice Address - Street 1:9291 MEDICAL PLAZA DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9126
Practice Address - Country:US
Practice Address - Phone:843-764-1730
Practice Address - Fax:843-764-1731
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022607363A00000X
SC4389363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant