Provider Demographics
NPI:1699496935
Name:MCCOY, KATIE N
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:N
Last Name:MCCOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:N
Other - Last Name:GORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:360 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAMLIN
Mailing Address - State:WV
Mailing Address - Zip Code:25523-1412
Mailing Address - Country:US
Mailing Address - Phone:304-824-3448
Mailing Address - Fax:
Practice Address - Street 1:360 MAIN ST
Practice Address - Street 2:
Practice Address - City:HAMLIN
Practice Address - State:WV
Practice Address - Zip Code:25523-1412
Practice Address - Country:US
Practice Address - Phone:304-824-3448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant