Provider Demographics
NPI:1063980316
Name:MCCOY, CONNIE B (FNP-C)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:B
Last Name:MCCOY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2000 S MAYS ST STE 201
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-7580
Mailing Address - Country:US
Mailing Address - Phone:512-244-4272
Mailing Address - Fax:806-665-8503
Practice Address - Street 1:7901 SW 34TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79121-1057
Practice Address - Country:US
Practice Address - Phone:806-350-7918
Practice Address - Fax:806-418-8982
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-05
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139633363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX390933502Medicaid
TXAP139633OtherTEXAS BOARD OF NURSING