Provider Demographics
NPI:1679719926
Name:MCCOY, KATHLEEN (NP)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:MCCOY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4500 WILLIAMS DRIVE STATION 212-277
Mailing Address - Street 2:110 EISENHOWER COURT
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633
Mailing Address - Country:US
Mailing Address - Phone:512-688-3854
Mailing Address - Fax:512-651-4666
Practice Address - Street 1:4500 WILLIAMS DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78633-1332
Practice Address - Country:US
Practice Address - Phone:512-688-3854
Practice Address - Fax:512-651-4666
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168104363L00000X
TXAP119783363LP2300X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care