Provider Demographics
NPI:1497989222
Name:MCCOY, LISA LYNN (ARNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:LYNN
Last Name:MCCOY
Suffix:
Gender:F
Credentials:ARNP, FNP-BC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:LYNN
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN,C
Mailing Address - Street 1:985 CANTRELL RD
Mailing Address - Street 2:
Mailing Address - City:EDDYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42038-8913
Mailing Address - Country:US
Mailing Address - Phone:270-804-9707
Mailing Address - Fax:888-535-9222
Practice Address - Street 1:985 CANTRELL RD
Practice Address - Street 2:
Practice Address - City:EDDYVILLE
Practice Address - State:KY
Practice Address - Zip Code:42038-8913
Practice Address - Country:US
Practice Address - Phone:270-804-9707
Practice Address - Fax:888-535-9222
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-07
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6005P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily