Individual
COURTNEY TIEREE SAMUELS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
2205 GREENTREE N, CLARKSVILLE, IN 47129-8957
(812) 218-6560
(812) 288-2605
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
3018888
KY
363LF0000X
Family Nurse Practitioner
Primary
71013451A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300072891
—
IN
01
—
3018888
STATE LICENSE
KY
05
—
7100954570
—
KY
01
—
71013451A
STATE LICENSE
IN
Enumeration date
01/17/2023
Last updated
02/20/2024
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