Provider Demographics
NPI:1275972796
Name:MCCOY, ALISA (RN)
Entity Type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:
Last Name:MCCOY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 OAKWOOD DR
Mailing Address - Street 2:PO BOX 22
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-1737
Mailing Address - Country:US
Mailing Address - Phone:307-254-0208
Mailing Address - Fax:
Practice Address - Street 1:644 OAKWOOD DR
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-1737
Practice Address - Country:US
Practice Address - Phone:307-254-0208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY18707163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse