Provider Demographics
NPI:1568946630
Name:MCCOY, CLAIR HOLLINS
Entity Type:Individual
Prefix:
First Name:CLAIR
Middle Name:HOLLINS
Last Name:MCCOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9363 PECAN TREE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-0700
Mailing Address - Country:US
Mailing Address - Phone:225-247-2213
Mailing Address - Fax:
Practice Address - Street 1:9363 PECAN TREE DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-0700
Practice Address - Country:US
Practice Address - Phone:225-247-2213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
309330174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN