Provider Demographics
NPI:1134568728
Name:MCCORD, LAURICE A (PNP-BC)
Entity type:Individual
Prefix:
First Name:LAURICE
Middle Name:A
Last Name:MCCORD
Suffix:
Gender:F
Credentials:PNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 OAKLAND LN
Mailing Address - Street 2:
Mailing Address - City:MAYNARDVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37807-3354
Mailing Address - Country:US
Mailing Address - Phone:865-992-9977
Mailing Address - Fax:865-992-1888
Practice Address - Street 1:147 OAKLAND LN
Practice Address - Street 2:
Practice Address - City:MAYNARDVILLE
Practice Address - State:TN
Practice Address - Zip Code:37807-3354
Practice Address - Country:US
Practice Address - Phone:659-929-9778
Practice Address - Fax:865-992-1888
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000076081163WP0200X
TNAPN6236363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics