Provider Demographics
NPI:1154508166
Name:MCCOY, KERRI JO (APRN,FNP)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:JO
Last Name:MCCOY
Suffix:
Gender:F
Credentials:APRN,FNP
Other - Prefix:
Other - First Name:KERRI
Other - Middle Name:JO
Other - Last Name:PRINGLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN,FNP
Mailing Address - Street 1:1303 38TH AVE N
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-1315
Mailing Address - Country:US
Mailing Address - Phone:843-448-4437
Mailing Address - Fax:
Practice Address - Street 1:3710 HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-5005
Practice Address - Country:US
Practice Address - Phone:663-892-7278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3299363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3299OtherSTATE LISCENSE