Provider Demographics
NPI:1629702964
Name:MCCOURY, YANCEY TAYLOR (PA-C)
Entity Type:Individual
Prefix:
First Name:YANCEY
Middle Name:TAYLOR
Last Name:MCCOURY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-887-4530
Mailing Address - Fax:704-887-4531
Practice Address - Street 1:10030 GILEAD RD STE 201
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7545
Practice Address - Country:US
Practice Address - Phone:704-887-4530
Practice Address - Fax:704-887-4531
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-13558363A00000X
NY028493363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant