Healthcare Provider Details

I. General information

NPI: 1639981533
Provider Name (Legal Business Name): DEONNA MCKOY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 FLAGSTONE LN
RAEFORD NC
28376-3260
US

IV. Provider business mailing address

1707 OWEN DR APT 257
FAYETTEVILLE NC
28304-0084
US

V. Phone/Fax

Practice location:
  • Phone: 516-201-1604
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: