Provider Demographics
NPI:1518712314
Name:MCKOY, TAWANDA LATASHA (CNAII)
Entity Type:Individual
Prefix:MRS
First Name:TAWANDA
Middle Name:LATASHA
Last Name:MCKOY
Suffix:
Gender:F
Credentials:CNAII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 TOWN CENTER DRIVE
Mailing Address - Street 2:STE 130 UNIT #172
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-0049
Mailing Address - Country:US
Mailing Address - Phone:833-454-7770
Mailing Address - Fax:833-454-7770
Practice Address - Street 1:3011 TOWN CENTER DRIVE
Practice Address - Street 2:STE 130 UNIT #172
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-0049
Practice Address - Country:US
Practice Address - Phone:833-454-7770
Practice Address - Fax:833-454-7770
Is Sole Proprietor?:No
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC108946376K00000X
NC6952376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide