1861745994 NPI number — MRS. SHERRY MARIE MCCOY PMHCNS, APRNBC

Table of content: MRS. SHERRY MARIE MCCOY PMHCNS, APRNBC (NPI 1861745994)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861745994 NPI number — MRS. SHERRY MARIE MCCOY PMHCNS, APRNBC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCOY
Provider First Name:
SHERRY
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PMHCNS, APRNBC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAY
Provider Other First Name:
SHERRY
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1861745994
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2960 CAMINO DIABLO STE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALNUT CREEK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94597-3945
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-892-2695
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 2ND AVE
Provider Second Line Business Practice Location Address:
REGUS AT THE NORTON BLDG
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98104-1576
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-892-2695
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/26/2012

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: 364SP0808X , with the licence number:  RN096899 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SP0808X , with the licence number: AP61211676 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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