MEDICARE: MS. JENNIFER LAUREN MCCOY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	3570	AL

General Provider Information

NPI Number	:	1831596717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER LAUREN MCCOY

Provider Business Mailing Address
First Line	:	411 OVERLOOK RD
Second Line	:
City	:	BOAZ
State	:	AL
Zip	:	35956-5928
Country	:	US
Telephone Number	:	256-490-7981
Fax Number	:

Provider Business Practice Location Address
First Line	:	411 OVERLOOK RD
Second Line	:
City	:	BOAZ
State	:	AL
Zip	:	35956-5928
Country	:	US
Telephone Number	:	256-490-7981
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2014
Last Update Date	:	11/20/2014

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