Provider Demographics
NPI:1396715033
Name:WHITE, COURTNEY DALLAS (PA C)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:DALLAS
Last Name:WHITE
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:MS
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:DALLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:13251 FALLS OF NEUSE RD STE 121
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-8573
Mailing Address - Country:US
Mailing Address - Phone:919-785-5055
Mailing Address - Fax:
Practice Address - Street 1:13251 FALLS OF NEUSE RD STE 121
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-8573
Practice Address - Country:US
Practice Address - Phone:919-785-5055
Practice Address - Fax:919-573-6689
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103974363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant