Provider Demographics
NPI:1053740290
Name:COMBE, COURTNEY M (PA-C)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:M
Last Name:COMBE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1775 W STATE ST # 383
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-3924
Mailing Address - Country:US
Mailing Address - Phone:208-912-4416
Mailing Address - Fax:208-549-7017
Practice Address - Street 1:3071 E FRANKLIN RD STE 201
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2376
Practice Address - Country:US
Practice Address - Phone:208-807-2877
Practice Address - Fax:208-207-2888
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-1121363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical