Healthcare Provider Details

I. General information

NPI: 1558197152
Provider Name (Legal Business Name): ANN MEREDITH MCCOY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10089 WILLOW CREEK RD STE 200
SAN DIEGO CA
92131-1699
US

IV. Provider business mailing address

3460 OVERBROOK DR
ROANOKE VA
24018-2500
US

V. Phone/Fax

Practice location:
  • Phone: 213-633-7505
  • Fax: 310-695-2730
Mailing address:
  • Phone: 213-633-7505
  • Fax: 310-695-2730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP95031550
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: