Provider Demographics
NPI:1104083120
Name:MCCOY, HARRIET R (NP)
Entity type:Individual
Prefix:
First Name:HARRIET
Middle Name:R
Last Name:MCCOY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5589 GREENWICH RD
Mailing Address - Street 2:SUITE 175
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6565
Mailing Address - Country:US
Mailing Address - Phone:757-216-9115
Mailing Address - Fax:757-216-9117
Practice Address - Street 1:5589 GREENWICH RD
Practice Address - Street 2:SUITE 175
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6565
Practice Address - Country:US
Practice Address - Phone:757-216-9115
Practice Address - Fax:757-216-9117
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164592363LF0000X
247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
W19369933Medicare UPIN