Provider Demographics
NPI:1699462895
Name:MCCOY, CASEY LAUREN (APRN)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:LAUREN
Last Name:MCCOY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:LAUREN
Other - Last Name:SHAVALIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1910 S ZERO ST STE B
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-8416
Mailing Address - Country:US
Mailing Address - Phone:479-259-9239
Mailing Address - Fax:
Practice Address - Street 1:1910 S ZERO ST STE B
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-8416
Practice Address - Country:US
Practice Address - Phone:479-259-9239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR223911363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily