Healthcare Provider Details

I. General information

NPI: 1366811366
Provider Name (Legal Business Name): HOLLY NICOLE MCCOY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2015
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 E 3RD ST UNIT 201
DURANGO CO
81301-5759
US

IV. Provider business mailing address

PO BOX 802793
KANSAS CITY MO
64180-2793
US

V. Phone/Fax

Practice location:
  • Phone: 970-764-7190
  • Fax: 970-375-7927
Mailing address:
  • Phone: 800-953-0104
  • Fax: 303-765-6670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.0007012
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0007012
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.200883
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: