Provider Demographics
NPI:1407170152
Name:MCCOY, LORI K (RN)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:K
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 1:3044 DREWERSBURG RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARRISON
Mailing Address - State:IN
Mailing Address - Zip Code:47060-9641
Mailing Address - Country:US
Mailing Address - Phone:812-637-9906
Mailing Address - Fax:
Practice Address - Street 1:3044 DREWERSBURG RD
Practice Address - Street 2:
Practice Address - City:WEST HARRISON
Practice Address - State:IN
Practice Address - Zip Code:47060-9641
Practice Address - Country:US
Practice Address - Phone:812-637-9906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-196532163WC0400X, 163WH0200X, 163WH1000X, 163WP0200X
OHRN196532163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WH1000XNursing Service ProvidersRegistered NurseHospice
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WX0200XNursing Service ProvidersRegistered NurseOncology