Provider Demographics
NPI:1457851032
Name:MCCOY, ANGELA DAWN (LVN)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:DAWN
Last Name:MCCOY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 PARKER RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76310-0436
Mailing Address - Country:US
Mailing Address - Phone:940-257-4725
Mailing Address - Fax:
Practice Address - Street 1:2540 PARKER RD
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76310-0436
Practice Address - Country:US
Practice Address - Phone:940-257-4725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX191458164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse