Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mrs. Courtney Paige Wall, PMHNP-BC

Individual provider Psychiatric/Mental Health Nurse Practitioner · NPI 1639796766

Mrs. Courtney Paige Wall, PMHNP-BC is a Nurse Practitioner in Saint Louis, Missouri. Qualified in 2020, 6 years ago. Practices with Provident Inc, a 19-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Missouri.

Years since qualifying
6
Licensed in
MO
In the registry since
2020
What do these letters mean?
PMHNP-BC — Psychiatric-Mental Health Nurse Practitioner, Board Certified
A board-certified psychiatric nurse practitioner.

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Practice location Address checks out

2650 Olive St
Saint Louis, MO 63103-1489
Phone: (314) 533-8200
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence 2020019958 (MO)

Record details

NPI number1639796766
Entity typeIndividual (Type 1)
GenderFemale
Credentials PMHNP-BC
Sole proprietorNo
NPI enumeratedJuly 6, 2020
Last updated in NPPESMay 27, 2021
Certification dateMay 27, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Provident Inc — 19 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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