Provider Demographics
NPI:1427626886
Name:KINSEY, COURTNEY LANE (NP)
Entity type:Individual
Prefix:MISS
First Name:COURTNEY
Middle Name:LANE
Last Name:KINSEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:202 CUMBERLAND DR
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:GA
Mailing Address - Zip Code:31008-6364
Mailing Address - Country:US
Mailing Address - Phone:850-544-5299
Mailing Address - Fax:
Practice Address - Street 1:639 HEMLOCK ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-6886
Practice Address - Country:US
Practice Address - Phone:478-755-1560
Practice Address - Fax:478-755-1562
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN227745363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner