Provider Demographics
NPI:1922849207
Name:BEVILLE-MATTINA, COURTNEY ANN
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ANN
Last Name:BEVILLE-MATTINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8101 RUE HOLLIFIELD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-7567
Mailing Address - Country:US
Mailing Address - Phone:228-327-2609
Mailing Address - Fax:
Practice Address - Street 1:8101 RUE HOLLIFIELD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-7567
Practice Address - Country:US
Practice Address - Phone:228-327-2609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker