Provider Demographics
NPI:1093914392
Name:TAMBERLY MCCOY, M.D. PLLC
Entity type:Organization
Organization Name:TAMBERLY MCCOY, M.D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMBERLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PLLC
Authorized Official - Phone:270-926-1150
Mailing Address - Street 1:2816 VEACH RD STE 308
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-6297
Mailing Address - Country:US
Mailing Address - Phone:270-926-1150
Mailing Address - Fax:270-926-2796
Practice Address - Street 1:2816 VEACH RD STE 308
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-6297
Practice Address - Country:US
Practice Address - Phone:270-926-1150
Practice Address - Fax:270-926-2796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYDB6058OtherRAILROAD MEDICARE
KY000000321559OtherANTHEM BCBS
KY65946071Medicaid
KYG99689Medicare UPIN
KY65946071Medicaid