Individual
COURTNEY A FUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
115 E GOLD ST STE 518, KINGS MOUNTAIN, NC 28086-3431
(980) 404-0678
Mailing address
P.O. BOX 518, KINGS MOUNTAIN, NC 28086-0518
(980) 404-0678
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
25902
SC
363L00000X
Nurse Practitioner
Primary
5010598
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
87-3728031
IRS
NC
Enumeration date
05/21/2018
Last updated
05/17/2022
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