Healthcare Provider Details

I. General information

NPI: 1407170152
Provider Name (Legal Business Name): LORI K MCCOY R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2010
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3044 DREWERSBURG RD
WEST HARRISON IN
47060-9641
US

IV. Provider business mailing address

3044 DREWERSBURG RD
WEST HARRISON IN
47060-9641
US

V. Phone/Fax

Practice location:
  • Phone: 812-637-9906
  • Fax:
Mailing address:
  • Phone: 812-637-9906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN-196532
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN-196532
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License NumberRN-196532
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN-196532
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License NumberRN196532
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: