Provider Demographics
NPI:1891036075
Name:MCCOY, JIVIDEN JAMES (PA-C)
Entity Type:Individual
Prefix:
First Name:JIVIDEN
Middle Name:JAMES
Last Name:MCCOY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 W KATHERINE P RAINES RD STE 300
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-7447
Mailing Address - Country:US
Mailing Address - Phone:325-672-4372
Mailing Address - Fax:325-673-0856
Practice Address - Street 1:2010 W KATHERINE P RAINES RD STE 300
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-7447
Practice Address - Country:US
Practice Address - Phone:817-556-3212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-12
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08350363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical