Healthcare Provider Details

I. General information

NPI: 1326391327
Provider Name (Legal Business Name): TENA MARIE MCCOY MSN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2012
Last Update Date: 06/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 GOLDSMITH RD
PARAGOULD AR
72450-9509
US

IV. Provider business mailing address

4275 W COUNTY ROAD 122
LEACHVILLE AR
72438-9073
US

V. Phone/Fax

Practice location:
  • Phone: 870-243-6639
  • Fax:
Mailing address:
  • Phone: 870-243-6639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberR33018
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberM01001
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberM001001
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: