Provider Demographics
NPI:1215181086
Name:MCCOY, KRISTY L (PA)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:L
Last Name:MCCOY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 NE LOOP 410 STE 375
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-4661
Mailing Address - Country:US
Mailing Address - Phone:210-634-1232
Mailing Address - Fax:210-634-1243
Practice Address - Street 1:2130 NE LOOP 410 STE 375
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217
Practice Address - Country:US
Practice Address - Phone:210-634-1232
Practice Address - Fax:210-634-1243
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05960363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant