Provider Demographics
NPI:1396725263
Name:MCCOY, JACQUELINE A (ARNP MS)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:A
Last Name:MCCOY
Suffix:
Gender:F
Credentials:ARNP MS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:555 DAYTON ST
Mailing Address - Street 2:STE C
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020
Mailing Address - Country:US
Mailing Address - Phone:425-774-4673
Mailing Address - Fax:425-774-0690
Practice Address - Street 1:555 DAYTON ST
Practice Address - Street 2:STE C
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020
Practice Address - Country:US
Practice Address - Phone:425-774-4673
Practice Address - Fax:425-774-0690
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00050601163W00000X
WAAP30000243363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AB20334Medicare ID - Type Unspecified