Provider Demographics
NPI:1235771197
Name:MCDERMOTT, COURTNEY RAE (PA-C)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:RAE
Last Name:MCDERMOTT
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:MS
Other - First Name:COURTNEY
Other - Middle Name:RAE
Other - Last Name:BOTELHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 80895
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89180-0895
Mailing Address - Country:US
Mailing Address - Phone:702-508-9119
Mailing Address - Fax:
Practice Address - Street 1:1701 N GREEN VALLEY PKWY STE 7B
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-5889
Practice Address - Country:US
Practice Address - Phone:702-508-9119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-11
Last Update Date:2025-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA2201363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant