Courtney Little
Individual provider Active NPI Contractor · Sikeston, MO
NPI 1154731446 · NPPES record last updated May 7, 2014
Key facts
- NPI
- 1154731446
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- 2014011836 (MO)
- Practice address
- 501 John R Blvd
Sikeston, MO 63801-2443 - Phone
- (573) 931-5349
- NPI assigned
- May 7, 2014
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2014011836 | MO | MD | Contractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 2014011836 | MO | Yes |
Addresses
Primary practice location
501 John R Blvd
Sikeston, MO 63801-2443
Mailing address
501 John R Blvd
Sikeston, MO 63801-2443
Phone (573) 931-5349
Other providers in Sikeston, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 7, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.