Provider Demographics
NPI:1588427876
Name:MCCOY, I'JON
Entity type:Individual
Prefix:
First Name:I'JON
Middle Name:
Last Name:MCCOY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 TURNSTONE CT
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-2312
Mailing Address - Country:US
Mailing Address - Phone:702-357-8317
Mailing Address - Fax:702-357-8317
Practice Address - Street 1:1117 TURNSTONE CT
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-2312
Practice Address - Country:US
Practice Address - Phone:702-357-8317
Practice Address - Fax:702-357-8317
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant