Provider Demographics
NPI:1902830540
Name:MCCOY, LAURIE KATHLEEN (APRN, BC)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:KATHLEEN
Last Name:MCCOY
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 MIDDLEBROOK RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-4939
Mailing Address - Country:US
Mailing Address - Phone:928-445-2638
Mailing Address - Fax:928-776-6084
Practice Address - Street 1:500 HWY 89
Practice Address - Street 2:#118
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86313
Practice Address - Country:US
Practice Address - Phone:928-717-7547
Practice Address - Fax:928-776-6084
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN046327363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily