Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 2020019398 | MO |
Y | 207R00000X | Internist | 2021036004 | MO |
Y | 111NI0900X | Internist | 2021036004 | MO |
NPI | 1407473614 |
---|---|
Provider Name | Dr. Courtney Van Ness |
First Address | Kirksville, MO 63501-2650 |
Second Address | Kirksville, MO 63501-6401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2020 |
Last Update Date | 22/01/2022 |