Individual
COURTNEY L MCMAHON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
705 RILEY HOSPITAL DR, INDIANAPOLIS, IN 46202-5109
(317) 944-9981
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
10003934A
IN
363AM0700X
Medical Physician Assistant
Primary
10003934A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300073082
—
IN
01
—
M400076100
MEDICARE
IN
Enumeration date
02/09/2023
Last updated
02/29/2024
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