Provider Demographics
NPI:1841304656
Name:COY, CAROL (NP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:COY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 505
Mailing Address - Street 2:
Mailing Address - City:NORTH CHILI
Mailing Address - State:NY
Mailing Address - Zip Code:14514-0505
Mailing Address - Country:US
Mailing Address - Phone:585-594-5995
Mailing Address - Fax:585-594-5425
Practice Address - Street 1:4201 BUFFALO ROAD, SUITE 1
Practice Address - Street 2:
Practice Address - City:NORTH CHILI
Practice Address - State:NY
Practice Address - Zip Code:14514-1256
Practice Address - Country:US
Practice Address - Phone:585-594-5995
Practice Address - Fax:585-594-5425
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400521-01363L00000X
NYF400521-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02076777Medicaid
NY02076777Medicaid