Provider Demographics
NPI:1558069757
Name:KANE, COURTNEY (FNP)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:KANE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3866 BELFAST KELLER RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-6863
Mailing Address - Country:US
Mailing Address - Phone:912-910-2720
Mailing Address - Fax:
Practice Address - Street 1:3866 BELFAST KELLER RD
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-6863
Practice Address - Country:US
Practice Address - Phone:912-910-2720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-17
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN270909363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily