Courtney Connolly

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

6176 Issued in AZ

Practice address

14502 W Meeker Blvd
Banner del E. Webb Emergency Dept
Sun City West, AZ 85375-5282

Phone

(623) 524-4067

Fax

(623) 524-4182

NPI assigned

Jul 22, 2015

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1437523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472601600000",
    "number": "1346625183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14502 W MEEKER BLVD",
            "address_2": "BANNER DEL E. WEBB EMERGENCY DEPT",
            "city": "SUN CITY WEST",
            "state": "AZ",
            "postal_code": "853755282",
            "telephone_number": "623-524-4067",
            "fax_number": "623-524-4182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14502 W MEEKER BLVD",
            "address_2": "BANNER DEL E. WEBB EMERGENCY DEPT",
            "city": "SUN CITY WEST",
            "state": "AZ",
            "postal_code": "853755282",
            "telephone_number": "623-524-4067",
            "fax_number": "623-524-4182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNOLLY",
        "first_name": "COURTNEY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-07-22",
        "last_updated": "2016-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "AZ",
            "license": "27-1369141",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "6176",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "THE MUTUAL",
            "identifier": "IN PROCESS",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Clinical Research Institute of Arizona, LLC
• Troy Coleman, DO
• Community Primary Care LLC
• Compudiagnostics Inc
• Kristen Allissa Connelly, PA-C
• Zachary Ryan Contursi, DO
• Mandi D Conway, MD
• Barbara Coohey, PT
• Philip Cooke, D.D.S.
• Lise G. Cote, ARNP C

• Medical Physician Assistant in Sun City West, AZ
• Providers in Sun City West, AZ by specialty
• Medical Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.