Healthcare Provider Details

I. General information

NPI: 1629292156
Provider Name (Legal Business Name): RACHELLE D MCCOY R N C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 04/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S DEER RD
MACOMB IL
61455-2639
US

IV. Provider business mailing address

14778 N CATHOLIC CEMETERY RD
LEWISTOWN IL
61542-8603
US

V. Phone/Fax

Practice location:
  • Phone: 309-837-4876
  • Fax: 309-833-1531
Mailing address:
  • Phone: 309-547-2287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number041.254419
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number041.254419
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: