Provider Demographics
NPI:1851631162
Name:MCCOY, JEANNETTE MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:MARIE
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 1:6990 SCRABBLE RD
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25443-4106
Mailing Address - Country:US
Mailing Address - Phone:580-341-0083
Mailing Address - Fax:
Practice Address - Street 1:209 CLOVER ST
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-3803
Practice Address - Country:US
Practice Address - Phone:304-263-8921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV30128164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse