Provider Demographics
NPI:1891713442
Name:DRISKELL-MCCOY, REBECCA LANORA (DMD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:LANORA
Last Name:DRISKELL-MCCOY
Suffix:
Gender:F
Credentials:DMD
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 429
Mailing Address - Street 2:
Mailing Address - City:HARDINSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40143-0429
Mailing Address - Country:US
Mailing Address - Phone:270-756-7950
Mailing Address - Fax:270-756-7949
Practice Address - Street 1:122 W THIRD ST.
Practice Address - Street 2:
Practice Address - City:HARDINSBURG
Practice Address - State:KY
Practice Address - Zip Code:40143
Practice Address - Country:US
Practice Address - Phone:270-756-7950
Practice Address - Fax:270-756-7949
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY74411223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist