Provider Demographics
NPI:1326391327
Name:MCCOY, TENA MARIE (MSN CNM)
Entity Type:Individual
Prefix:MRS
First Name:TENA
Middle Name:MARIE
Last Name:MCCOY
Suffix:
Gender:F
Credentials:MSN CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4275 W COUNTY ROAD 122
Mailing Address - Street 2:
Mailing Address - City:LEACHVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72438-9073
Mailing Address - Country:US
Mailing Address - Phone:870-243-6639
Mailing Address - Fax:
Practice Address - Street 1:801 GOLDSMITH RD
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-9509
Practice Address - Country:US
Practice Address - Phone:870-243-6639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR33018163WC1500X
ARM01001163WW0101X
ARM001001367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory