Provider Demographics
NPI:1831642776
Name:MCCOY, MARY BETH (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:BETH
Last Name:MCCOY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 N CHANCERY ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-2048
Mailing Address - Country:US
Mailing Address - Phone:931-474-4700
Mailing Address - Fax:931-474-4701
Practice Address - Street 1:306 N CHANCERY ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-2048
Practice Address - Country:US
Practice Address - Phone:931-474-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-27
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21509363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily