Provider Demographics
NPI:1891593430
Name:WILFONG, COURTNEY N
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:N
Last Name:WILFONG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 N KANAWHA ST APT 4
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-2784
Mailing Address - Country:US
Mailing Address - Phone:304-435-8525
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 2153
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-7153
Practice Address - Country:US
Practice Address - Phone:304-473-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer