Provider Demographics
NPI:1669853156
Name:MCCOY, CHARITY (APRN)
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:
Last Name:MCCOY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CHARITY
Other - Middle Name:
Other - Last Name:PAUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4966 GLENWAY AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-3905
Mailing Address - Country:US
Mailing Address - Phone:513-242-7164
Mailing Address - Fax:
Practice Address - Street 1:4966 GLENWAY AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-3905
Practice Address - Country:US
Practice Address - Phone:513-242-7164
Practice Address - Fax:513-244-2160
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010096363LF0000X
IN71006234A363LF0000X
OHCOA.19008-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3010096OtherKY LICENSE