Provider Demographics
NPI:1922083286
Name:MCCOY, BEVERLY JEAN (FNP)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:JEAN
Last Name:MCCOY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:JEAN
Other - Last Name:MADTSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NONE AT THAT TIME
Mailing Address - Street 1:73015 HIGHWAY 25 STE A
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70435-5694
Mailing Address - Country:US
Mailing Address - Phone:985-246-2420
Mailing Address - Fax:
Practice Address - Street 1:73015 HIGHWAY 25 STE A
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70435-5694
Practice Address - Country:US
Practice Address - Phone:985-246-2420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN060670, APN 321363LF0000X
LA138790 07087363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ593259Medicare UPIN