Provider Demographics
NPI:1083132898
Name:MCKOY, RAVON LAMONT (FNP)
Entity Type:Individual
Prefix:MR
First Name:RAVON
Middle Name:LAMONT
Last Name:MCKOY
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9714 SPRINGHOLM DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-6663
Mailing Address - Country:US
Mailing Address - Phone:919-423-0997
Mailing Address - Fax:
Practice Address - Street 1:442 S HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:NC
Practice Address - Zip Code:28164-2055
Practice Address - Country:US
Practice Address - Phone:704-263-1416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5009840363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily