Provider Demographics
NPI:1720102866
Name:MCCOY, KATHRYN LORENE (LMP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LORENE
Last Name:MCCOY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8892
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-0056
Mailing Address - Country:US
Mailing Address - Phone:253-639-1335
Mailing Address - Fax:
Practice Address - Street 1:321 BURNETT AVE S
Practice Address - Street 2:SUITE #305
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-2558
Practice Address - Country:US
Practice Address - Phone:253-332-5342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019955174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist