Provider Demographics
NPI:1861047466
Name:VILLASUSO, COURTNEY ATKINS (PA-C)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ATKINS
Last Name:VILLASUSO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:PAIGE
Other - Last Name:ATKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1921
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-1921
Mailing Address - Country:US
Mailing Address - Phone:828-818-8808
Mailing Address - Fax:
Practice Address - Street 1:11 FALCON CREST LN
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-6620
Practice Address - Country:US
Practice Address - Phone:828-565-0560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-09
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-15185363A00000X
SC3571363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4228PAMedicaid