Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 11906A | WY |
Y | 207RC0000X | Internist - Cardiovascular Disease | 11906A | WY |
NPI | 1285672303 |
---|---|
Provider Name | Dr. Kevin A Courville |
First Address | Lafayette, LA 70598-2298 |
Second Address | Lander, WY 82520-3410 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 13/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11906A | WYOMING BOARD OF MEDICINE (01) | WY |
152503400 | (05) | WY |
I10239 | (02) | LA |