Provider Demographics
NPI:1346429008
Name:CHRISTY MCCOY, LLC
Entity Type:Organization
Organization Name:CHRISTY MCCOY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:859-492-6783
Mailing Address - Street 1:2159 CHRISMAN MILL RD
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-9680
Mailing Address - Country:US
Mailing Address - Phone:859-492-6783
Mailing Address - Fax:859-879-9648
Practice Address - Street 1:2159 CHRISMAN MILL RD
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-9680
Practice Address - Country:US
Practice Address - Phone:859-492-6783
Practice Address - Fax:859-879-9648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3018P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9597Medicare PIN