1902830540 NPI number — MS. LAURIE KATHLEEN MCCOY APRN, BC

Table of content: MS. LAURIE KATHLEEN MCCOY APRN, BC (NPI 1902830540)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902830540 NPI number — MS. LAURIE KATHLEEN MCCOY APRN, BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCOY
Provider First Name:
LAURIE
Provider Middle Name:
KATHLEEN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN, BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902830540
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1015 MIDDLEBROOK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRESCOTT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86303-4939
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-445-2638
Provider Business Mailing Address Fax Number:
928-776-6084

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 HWY 89
Provider Second Line Business Practice Location Address:
#118
Provider Business Practice Location Address City Name:
PRESCOTT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-717-7547
Provider Business Practice Location Address Fax Number:
928-776-6084
Provider Enumeration Date:
07/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  RN046327 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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