Provider Demographics
NPI:1508750845
Name:MCCOY, SEAN GREGORY (FNP)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:GREGORY
Last Name:MCCOY
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5819 TRAIL AVE NE APT 303
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-3300
Mailing Address - Country:US
Mailing Address - Phone:562-533-1549
Mailing Address - Fax:
Practice Address - Street 1:4600 EVERGREEN ST SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322-6318
Practice Address - Country:US
Practice Address - Phone:541-812-4662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10042161363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner