Provider Demographics
NPI:1457638678
Name:MCCOY, AMANDA JO (RN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JO
Last Name:MCCOY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 NORTH 5TH STREET
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:IL
Mailing Address - Zip Code:62806
Mailing Address - Country:US
Mailing Address - Phone:618-445-2615
Mailing Address - Fax:618-445-3851
Practice Address - Street 1:329 NORTH 5TH STREET
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:IL
Practice Address - Zip Code:62806
Practice Address - Country:US
Practice Address - Phone:618-445-2615
Practice Address - Fax:618-445-3851
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28166090A163W00000X
IL041.348339163WG0000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice