Healthcare Provider Details

I. General information

NPI: 1386739464
Provider Name (Legal Business Name): TAMBERLY L MCCOY M.D.,PLLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2816 VEACH RD STE 308
OWENSBORO KY
42303-6297
US

IV. Provider business mailing address

2816 VEACH RD STE 308
OWENSBORO KY
42303-6297
US

V. Phone/Fax

Practice location:
  • Phone: 270-926-1150
  • Fax: 270-926-2796
Mailing address:
  • Phone: 270-926-1190
  • Fax: 270-926-2796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34958
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3011631
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: