Provider Demographics
NPI:1689109431
Name:MCCOY R.N.
Entity type:Organization
Organization Name:MCCOY R.N.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:304-475-2192
Mailing Address - Street 1:57 POLK ST
Mailing Address - Street 2:
Mailing Address - City:DELBARTON
Mailing Address - State:WV
Mailing Address - Zip Code:25670-1107
Mailing Address - Country:US
Mailing Address - Phone:304-475-2192
Mailing Address - Fax:304-475-3817
Practice Address - Street 1:57 POLK ST
Practice Address - Street 2:
Practice Address - City:DELBARTON
Practice Address - State:WV
Practice Address - Zip Code:25670-1107
Practice Address - Country:US
Practice Address - Phone:304-475-2192
Practice Address - Fax:304-475-3817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV89109251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV89109OtherREGISTERED NURSE LICENSE