Individual ProviderCourtney Helman SuponNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address6835 Austin Center Blvd, Austin, TX 78731-3166(512) 346-6611PECOS EnrollmentBased on the most recent information from CMS, provider Courtney Helman Supon does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 9:13 AM.Profile DetailsProvider ID1104282920Provider TypeIndividualFull NameSupon, Courtney HelmanCredentialRN, FNP-CGenderFemaleSole ProprietorNoEnumeration Date1/8/2016Last Updated2/1/2018Contact InformationPractice LocationPractice Address6835 Austin Center Blvd, Austin, TX 78731-3166Phone(512) 346-6611Fax(512) 406-7315Mailing LocationMailing Address4515 Seton Center Pkwy, Suite 215, Austin, TX 78759-5290PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseAP129597TexasCode363LF0000XDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense95003474CaliforniaProvider IdentifiersIDDescriptionIssuerID358112602DescriptionMedicaidIssuerUnlistedTexasID358112601DescriptionMedicaidIssuerUnlistedTexas