Provider Demographics
NPI:1023833704
Name:MCCOY, KIARA (APRN)
Entity type:Individual
Prefix:
First Name:KIARA
Middle Name:
Last Name:MCCOY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 WESTRIDGE PKWY STE 714
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-7789
Mailing Address - Country:US
Mailing Address - Phone:478-461-2820
Mailing Address - Fax:
Practice Address - Street 1:750 HAZEL ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-6856
Practice Address - Country:US
Practice Address - Phone:478-461-2820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN289403363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health