Basic Information
| Provider Information | |||||||||
| NPI: | 1285608372 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCOY | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 848476 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752848476 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2542024655 | ||||||||
| FaxNumber: | 2542024697 | ||||||||
| Practice Location | |||||||||
| Address1: | 7702 CENTRAL PARK DR | ||||||||
| Address2: | |||||||||
| City: | WACO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 767126535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2542027700 | ||||||||
| FaxNumber: | 2542027710 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2006 | ||||||||
| LastUpdateDate: | 09/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 556952 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 363LF0000X | 556952 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | AP109609 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 41484901 | 05 | TX | MEDICAID | 86N749 | 01 | TX | BC BS | OTHER |