Provider Demographics
NPI:1497005433
Name:MCCOY, MICHELLE KATHLEEN (DNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:KATHLEEN
Last Name:MCCOY
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:KATHLEEN
Other - Last Name:NAPRAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:525 PORTLAND AVE # MC963
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1533
Mailing Address - Country:US
Mailing Address - Phone:612-348-5553
Mailing Address - Fax:612-466-9790
Practice Address - Street 1:525 PORTLAND AVE # MC963
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1533
Practice Address - Country:US
Practice Address - Phone:612-348-5553
Practice Address - Fax:612-466-9790
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR210252-4363LF0000X
MN0347363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily