Provider Demographics
NPI:1174076905
Name:MCCOY, ASHLEY (RN)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:MCCOY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:AR
Mailing Address - Zip Code:72360-2102
Mailing Address - Country:US
Mailing Address - Phone:870-295-5280
Mailing Address - Fax:870-295-5390
Practice Address - Street 1:401 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:AR
Practice Address - Zip Code:72360-2102
Practice Address - Country:US
Practice Address - Phone:870-295-5280
Practice Address - Fax:870-295-5390
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR079401163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse