Provider Demographics
NPI:1477335354
Name:MCCOY, KEVIN (OPERATING AUTHORITY)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:MCCOY
Suffix:
Gender:M
Credentials:OPERATING AUTHORITY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8710 HOLLY HILL RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-5620
Mailing Address - Country:US
Mailing Address - Phone:804-300-8109
Mailing Address - Fax:
Practice Address - Street 1:8710 HOLLY HILL RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-5620
Practice Address - Country:US
Practice Address - Phone:804-300-8109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT67149304172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver