Provider Demographics
NPI:1457249997
Name:COURTNEY, KATIE ANN (FNP-BC)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:ANN
Last Name:COURTNEY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9367 S STREET RD
Mailing Address - Street 2:
Mailing Address - City:LE ROY
Mailing Address - State:NY
Mailing Address - Zip Code:14482-8932
Mailing Address - Country:US
Mailing Address - Phone:716-954-3966
Mailing Address - Fax:
Practice Address - Street 1:60 RED JACKET ST
Practice Address - Street 2:
Practice Address - City:DANSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14437-1769
Practice Address - Country:US
Practice Address - Phone:585-335-6041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2025024250363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner