Provider Demographics
NPI:1205162047
Name:MCCOY, KATRINA RAY (APRN)
Entity type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:RAY
Last Name:MCCOY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:S
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1065 OLD EKRON RD
Mailing Address - Street 2:
Mailing Address - City:BRANDENBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40108-1735
Mailing Address - Country:US
Mailing Address - Phone:270-422-2200
Mailing Address - Fax:270-422-2221
Practice Address - Street 1:1065 OLD EKRON RD
Practice Address - Street 2:
Practice Address - City:BRANDENBURG
Practice Address - State:KY
Practice Address - Zip Code:40108-1735
Practice Address - Country:US
Practice Address - Phone:270-422-2200
Practice Address - Fax:270-422-2221
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006200363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100097730Medicaid
KY1094126OtherRN LICENSE
IN200969950Medicaid
IN200969950Medicaid
KY7100097730Medicaid
KYK056541Medicare PIN