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Individual

KOURTNEY M BABCOCK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 888-5858
Mailing address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 888-5858

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA055120
PA
363A00000X
Physician Assistant
OA002768
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
03634493
NY
Enumeration date
11/10/2011
Last updated
03/04/2021
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