Provider Demographics
NPI:1588023279
Name:MCCOY, REGINA (NP-C)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
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 1:1507 N ROAD ST STE 3
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3283
Mailing Address - Country:US
Mailing Address - Phone:252-335-2963
Mailing Address - Fax:252-335-2636
Practice Address - Street 1:1507 N ROAD ST STE 3
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909
Practice Address - Country:US
Practice Address - Phone:252-335-2963
Practice Address - Fax:252-335-2636
Is Sole Proprietor?:No
Enumeration Date:2016-02-23
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174447363L00000X
NC5008254363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner