Provider Demographics
NPI:1922710813
Name:MCCOY, DONALD WADE
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:WADE
Last Name:MCCOY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 HURRICANE BR
Mailing Address - Street 2:
Mailing Address - City:DINGESS
Mailing Address - State:WV
Mailing Address - Zip Code:25671-6492
Mailing Address - Country:US
Mailing Address - Phone:304-752-9678
Mailing Address - Fax:
Practice Address - Street 1:86 HURRICANE BR
Practice Address - Street 2:
Practice Address - City:DINGESS
Practice Address - State:WV
Practice Address - Zip Code:25671-6491
Practice Address - Country:US
Practice Address - Phone:304-752-9678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-22
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker