Provider Demographics
NPI:1871710509
Name:BICKETT, COURTNEY CUPP (FNP)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:CUPP
Last Name:BICKETT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:COURTNEY
Other - Middle Name:DANA
Other - Last Name:CUPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 N HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23221-2601
Mailing Address - Country:US
Mailing Address - Phone:804-355-4358
Mailing Address - Fax:804-355-5216
Practice Address - Street 1:201 N HAMILTON ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23221-2601
Practice Address - Country:US
Practice Address - Phone:804-355-4358
Practice Address - Fax:804-355-5216
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165795363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily