Provider Demographics
NPI:1285948737
Name:MCCOY, STACY LYNN (CNP)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:LYNN
Last Name:MCCOY
Suffix:
Gender:
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5273 W ELKTON RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-8427
Mailing Address - Country:US
Mailing Address - Phone:513-720-8113
Mailing Address - Fax:
Practice Address - Street 1:1010 SUMMIT DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-3400
Practice Address - Country:US
Practice Address - Phone:513-424-0122
Practice Address - Fax:513-424-3863
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.350263163W00000X, 163W00000X
OH021098363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH366490OtherMEDICARE PTAN
OH0243325Medicaid