Provider Demographics
NPI:1710231238
Name:MCCOY, ALAINA A (MS PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ALAINA
Middle Name:A
Last Name:MCCOY
Suffix:
Gender:F
Credentials:MS PA-C
Other - Prefix:
Other - First Name:ALAINA
Other - Middle Name:A
Other - Last Name:SUTHERLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS PA-C
Mailing Address - Street 1:100 E. IDAHO ST.
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712
Mailing Address - Country:US
Mailing Address - Phone:208-345-5250
Mailing Address - Fax:
Practice Address - Street 1:100 E. IDAHO ST.
Practice Address - Street 2:SUITE 400
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712
Practice Address - Country:US
Practice Address - Phone:208-345-5250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-06
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-1340363AM0700X
WI3053-23363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical