Provider Demographics
NPI:1619953874
Name:MCCOY, KRISTIN RENEE (MD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:RENEE
Last Name:MCCOY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1605 SUMMERGLOW LN
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-6123
Mailing Address - Country:US
Mailing Address - Phone:303-475-9839
Mailing Address - Fax:
Practice Address - Street 1:1605 SUMMERGLOW LN
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-6123
Practice Address - Country:US
Practice Address - Phone:303-475-9839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38303207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO51035278Medicaid
COC806889Medicare PIN
COH27125Medicare UPIN
CO313168Medicare ID - Type Unspecified