Provider Demographics
NPI:1972142412
Name:MCCORD, BECKY JO (CRNP-FNP-BC)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:JO
Last Name:MCCORD
Suffix:
Gender:F
Credentials:CRNP-FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:574 CASANOVA RD
Mailing Address - Street 2:
Mailing Address - City:PHILIPSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16866-9004
Mailing Address - Country:US
Mailing Address - Phone:814-577-7856
Mailing Address - Fax:
Practice Address - Street 1:1114 WALTON ST
Practice Address - Street 2:
Practice Address - City:PHILIPSBURG
Practice Address - State:PA
Practice Address - Zip Code:16866-2748
Practice Address - Country:US
Practice Address - Phone:814-577-7856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-01
Last Update Date:2020-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP021280363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily