Healthcare Provider Details

I. General information

NPI: 1376388983
Provider Name (Legal Business Name): KAYLA ANN MCCOY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2024
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E COMMERCE ST
HERNANDO MS
38632-2456
US

IV. Provider business mailing address

1250 E COMMERCE ST
HERNANDO MS
38632-2456
US

V. Phone/Fax

Practice location:
  • Phone: 662-298-2238
  • Fax:
Mailing address:
  • Phone: 662-298-2238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number906671
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: