Healthcare Provider Details

I. General information

NPI: 1194550772
Provider Name (Legal Business Name): KRISTEN MCCOY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2279 45TH ST
SACRAMENTO CA
95817-1514
US

IV. Provider business mailing address

624 SETUCKET CT
ROSEVILLE CA
95747-4121
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-2703
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0218X
TaxonomyPediatric Oncology Registered Nurse
License Number765028
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: