Individual
STEPHANIE LYNN COURTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
118 MARKET ST, MANNINGTON, WV 26582-1131
(304) 986-1750
(304) 986-3742
Mailing address
PO BOX 1112, FAIRMONT, WV 26555-1112
(304) 366-0700
(304) 367-8766
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2525
WV
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1215539721
—
WV
Enumeration date
11/10/2020
Last updated
12/07/2021
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