Provider Demographics
NPI:1083645998
Name:MCCOY, SANDRA JEAN (RN, CBN, MSN, FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:JEAN
Last Name:MCCOY
Suffix:
Gender:F
Credentials:RN, CBN, MSN, FNP-BC
Other - Prefix:
Other - First Name:SANDY
Other - Middle Name:JEAN
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, CBN, MSN, FNP-BC
Mailing Address - Street 1:2101 TEAKWOOD LN STE 300
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-4420
Mailing Address - Country:US
Mailing Address - Phone:214-725-0716
Mailing Address - Fax:
Practice Address - Street 1:2101 TEAKWOOD LN STE 300
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-4420
Practice Address - Country:US
Practice Address - Phone:214-396-4916
Practice Address - Fax:972-474-1370
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX436534363L00000X
TXAP106313363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C1275Medicare PIN
TXS91402Medicare UPIN