Provider Demographics
NPI:1326552860
Name:MCCOY, EBONI GRACE (NP-C)
Entity Type:Individual
Prefix:MS
First Name:EBONI
Middle Name:GRACE
Last Name:MCCOY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 CUPOLA DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-3437
Mailing Address - Country:US
Mailing Address - Phone:919-880-8115
Mailing Address - Fax:
Practice Address - Street 1:721 TILGHMAN DR
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-6063
Practice Address - Country:US
Practice Address - Phone:910-304-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5010062363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner