Provider Demographics
NPI:1194457465
Name:MCCOY, JORDAN BROOKE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:BROOKE
Last Name:MCCOY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10960 CUMBERLAND GAP RD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:VA
Mailing Address - Zip Code:24127-7779
Mailing Address - Country:US
Mailing Address - Phone:304-887-6586
Mailing Address - Fax:
Practice Address - Street 1:810 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-7023
Practice Address - Country:US
Practice Address - Phone:540-951-3311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024184547363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty