Provider Demographics
NPI:1104309004
Name:MCCOY, JAMIE ROCHELLE (LVN)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:ROCHELLE
Last Name:MCCOY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 N MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TX
Mailing Address - Zip Code:75652-5937
Mailing Address - Country:US
Mailing Address - Phone:903-921-7190
Mailing Address - Fax:
Practice Address - Street 1:805 N MARSHALL ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TX
Practice Address - Zip Code:75652-5937
Practice Address - Country:US
Practice Address - Phone:903-921-7190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX320783164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse