Provider Demographics
NPI:1689894529
Name:MCCOY, JESSICA JEAN (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:JEAN
Last Name:MCCOY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:677 100TH ST SE
Mailing Address - Street 2:
Mailing Address - City:BYRON CENTER
Mailing Address - State:MI
Mailing Address - Zip Code:49315-8770
Mailing Address - Country:US
Mailing Address - Phone:616-915-0369
Mailing Address - Fax:
Practice Address - Street 1:125 S KALAMAZOO MALL
Practice Address - Street 2:SUITE 206
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-4832
Practice Address - Country:US
Practice Address - Phone:269-343-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301085977207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine