Provider Demographics
NPI:1740039023
Name:MCCOY, AMBER RENAE (CARE COORDINATOR)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:RENAE
Last Name:MCCOY
Suffix:
Gender:M
Credentials:CARE COORDINATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1198 OLD JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-3428
Mailing Address - Country:US
Mailing Address - Phone:573-760-1616
Mailing Address - Fax:573-760-1010
Practice Address - Street 1:1198 OLD JACKSON RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-3428
Practice Address - Country:US
Practice Address - Phone:573-760-1616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator