Provider Demographics
NPI:1437792033
Name:MCCOY, ASHLEY LAURA (PA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LAURA
Last Name:MCCOY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 CENTRAL AVE S STE 102
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-7430
Mailing Address - Country:US
Mailing Address - Phone:253-397-8683
Mailing Address - Fax:
Practice Address - Street 1:1314 CENTRAL AVE S STE 102
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-7430
Practice Address - Country:US
Practice Address - Phone:253-397-8683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-26
Last Update Date:2023-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61172807363A00000X
CA58399363A00000X
WAPA61172807363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty