Provider Demographics
NPI:1891463253
Name:MCCOY, KENDALL JEAN (CNM)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:JEAN
Last Name:MCCOY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:688 SAINT MARKS AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-3697
Mailing Address - Country:US
Mailing Address - Phone:443-562-5233
Mailing Address - Fax:
Practice Address - Street 1:522 3RD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3003
Practice Address - Country:US
Practice Address - Phone:443-562-5233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF002098-01367A00000X
NY002098176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife