Provider Demographics
NPI:1851810030
Name:MCCOY, MARTHA LOUISE (NP-C)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:LOUISE
Last Name:MCCOY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:482 MCCOY ROAD
Mailing Address - Street 2:
Mailing Address - City:FLEMING
Mailing Address - State:OH
Mailing Address - Zip Code:45729
Mailing Address - Country:US
Mailing Address - Phone:740-678-2477
Mailing Address - Fax:
Practice Address - Street 1:207D COLEGATE DR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-2363
Practice Address - Country:US
Practice Address - Phone:740-376-0930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.021499363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner