Provider Demographics
NPI:1942086616
Name:MCCOY, LYDIA RUTH
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:RUTH
Last Name:MCCOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 COUNTY ROAD 343
Mailing Address - Street 2:
Mailing Address - City:FALKNER
Mailing Address - State:MS
Mailing Address - Zip Code:38629-9491
Mailing Address - Country:US
Mailing Address - Phone:662-415-6727
Mailing Address - Fax:
Practice Address - Street 1:407 MAPLE ST
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:MS
Practice Address - Zip Code:38663-2606
Practice Address - Country:US
Practice Address - Phone:662-415-6727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty