Provider Demographics
NPI:1265724777
Name:MCCOY, MAUREEN (NP-C)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:MCCOY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:
Other - Last Name:CONLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:722 LOUGHBOROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63111-2732
Mailing Address - Country:US
Mailing Address - Phone:314-616-5537
Mailing Address - Fax:636-333-4522
Practice Address - Street 1:5000 CEDAR PLAZA PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-4345
Practice Address - Country:US
Practice Address - Phone:314-616-5537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011003422363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily