Provider Demographics
NPI:1538141163
Name:MCCOY, VIRGINIA L (CNP)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:L
Last Name:MCCOY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 N MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44310-1449
Mailing Address - Country:US
Mailing Address - Phone:330-920-9497
Mailing Address - Fax:330-923-0508
Practice Address - Street 1:275 GRAHAM RD
Practice Address - Street 2:SUITE 11
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-2203
Practice Address - Country:US
Practice Address - Phone:330-923-0094
Practice Address - Fax:330-920-7533
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN116899363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2173151Medicaid
OH2173151Medicaid
NDS95940Medicare UPIN