Provider Demographics
NPI:1639299720
Name:MCCOY, JOVANKA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JOVANKA
Middle Name:
Last Name:MCCOY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 CASSINO RD
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:VA
Mailing Address - Zip Code:23801-1317
Mailing Address - Country:US
Mailing Address - Phone:804-734-9081
Mailing Address - Fax:804-734-9053
Practice Address - Street 1:USA MEDDAC KAHC
Practice Address - Street 2:700 24TH STREET BLDG. 8151
Practice Address - City:FT LEE
Practice Address - State:VA
Practice Address - Zip Code:23801-1716
Practice Address - Country:US
Practice Address - Phone:804-734-9081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX129497164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse