Provider Demographics
NPI:1457484610
Name:MCCOY, JEWEL D (NURSE'S AIDE)
Entity Type:Individual
Prefix:
First Name:JEWEL
Middle Name:D
Last Name:MCCOY
Suffix:
Gender:F
Credentials:NURSE'S AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 MEADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-5002
Mailing Address - Country:US
Mailing Address - Phone:931-363-5731
Mailing Address - Fax:
Practice Address - Street 1:209 S CEDAR LN
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-3502
Practice Address - Country:US
Practice Address - Phone:931-363-5506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide