Individual
COURTNEY THACKER MCKILLOP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
490 PINEVIEW DR STE A, KERNERSVILLE, NC 27284-3995
(336) 992-2340
(336) 992-2350
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(336) 992-2340
(336) 992-2350
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
5021509
NC
363LP2300X
Primary Care Nurse Practitioner
Primary
5021509
NC
Other
Enumeration date
01/08/2025
Last updated
03/17/2025
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