Provider Demographics
NPI:1417087404
Name:MCCOY, TAMERA L (RN)
Entity Type:Individual
Prefix:
First Name:TAMERA
Middle Name:L
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 1:31765 HEADGATE RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-8905
Mailing Address - Country:US
Mailing Address - Phone:541-967-3888
Mailing Address - Fax:541-924-6911
Practice Address - Street 1:315 4TH STREET
Practice Address - Street 2:COURT HOUSE ANNEX
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321
Practice Address - Country:US
Practice Address - Phone:541-967-3888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health