Healthcare Provider Details

I. General information

NPI: 1447494893
Provider Name (Legal Business Name): JEFFREY S COY CNS-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2009
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3704 N OPPORTUNITY DR
CONNERSVILLE IN
47331-1017
US

IV. Provider business mailing address

P.O. BOX 236
BATESVILLE IN
47006-0236
US

V. Phone/Fax

Practice location:
  • Phone: 765-377-1300
  • Fax:
Mailing address:
  • Phone: 812-932-3371
  • Fax: 812-932-3506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number28191810A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSO2234
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71003452A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number71003452A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: