Basic Information
| Provider Information | |||||||||
| NPI: | 1215926282 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCOY | ||||||||
| FirstName: | JACQUELINE | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | F.N.P., M.S.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4801 ALBERTA AVE | ||||||||
| Address2: | EMERGENCY MEDICINE DEPARTMENT | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799052705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9152154600 | ||||||||
| FaxNumber: | 9155457338 | ||||||||
| Practice Location | |||||||||
| Address1: | 4815 ALAMEDA AVE | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799052705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155217415 | ||||||||
| FaxNumber: | 9155217920 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2005 | ||||||||
| LastUpdateDate: | 06/13/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 628905 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 175529001 | 05 | TX | MEDICAID |