Provider Demographics
NPI:1184904708
Name:MCCOY, ARLENA DAWN (08/31/1967)
Entity type:Individual
Prefix:MRS
First Name:ARLENA
Middle Name:DAWN
Last Name:MCCOY
Suffix:
Gender:F
Credentials:08/31/1967
Other - Prefix:MRS
Other - First Name:ARLENA
Other - Middle Name:DAWN
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:08/31/1967
Mailing Address - Street 1:18402 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:OH
Mailing Address - Zip Code:44609-9798
Mailing Address - Country:US
Mailing Address - Phone:330-938-6290
Mailing Address - Fax:
Practice Address - Street 1:18402 5TH ST
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:OH
Practice Address - Zip Code:44609-9798
Practice Address - Country:US
Practice Address - Phone:330-938-6290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker