Provider Demographics
NPI:1215437058
Name:MCCOY, REKITA DECHELLE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:REKITA
Middle Name:DECHELLE
Last Name:MCCOY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 RIVERWIND DR STE 104
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-5652
Mailing Address - Country:US
Mailing Address - Phone:601-345-4044
Mailing Address - Fax:601-510-9334
Practice Address - Street 1:200 RIVERWIND DR STE 104
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-5652
Practice Address - Country:US
Practice Address - Phone:601-345-4044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2022-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMCCO-RFN3U1207Q00000X
MSF01180598207Q00000X
MS902513363L00000X, 363LP0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1215437058Medicaid