Basic Information
| Provider Information | |||||||||
| NPI: | 1538141163 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCOY | ||||||||
| FirstName: | VIRGINIA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1037 N MAIN ST | ||||||||
| Address2: | SUITE B | ||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443101449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3309209497 | ||||||||
| FaxNumber: | 3309230508 | ||||||||
| Practice Location | |||||||||
| Address1: | 275 GRAHAM RD | ||||||||
| Address2: | SUITE 11 | ||||||||
| City: | CUYAHOGA FALLS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442232203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3309230094 | ||||||||
| FaxNumber: | 3309207533 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2005 | ||||||||
| LastUpdateDate: | 11/25/2013 | ||||||||
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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 | 363LA2100X | RN116899 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
ID Information
| ID | Type | State | Issuer | Description | 2173151 | 05 | OH | MEDICAID |