Provider Demographics
NPI:1518417856
Name:MCCOY, KRISTEN CARROLL (NP-C)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:CARROLL
Last Name:MCCOY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 LAKELAND DR STE 61
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4682
Mailing Address - Country:US
Mailing Address - Phone:601-982-7850
Mailing Address - Fax:601-366-8507
Practice Address - Street 1:970 LAKELAND DR STE 61
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4682
Practice Address - Country:US
Practice Address - Phone:601-982-7850
Practice Address - Fax:601-366-8507
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901718363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily