Individual
CARLA MCCOURT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
891 EAST BALTIMORE PIKE, KENNETT SQUARE, PA 19348
(610) 444-0113
(610) 444-0744
Mailing address
891 EAST BALTIMORE PIKE, KENNETT SQUARE, PA 19348
(610) 444-0113
(610) 444-0744
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
TP006184D
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002728
PRESCRIPTION AUTH
PA
01
—
98101
NURSE CERTIFICATION
PA
01
—
RN333161L
RN LICENSE
PA
01
—
TP006184D
CRNP LICENSE
PA
Enumeration date
05/15/2007
Last updated
07/08/2007
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