Healthcare Provider Details

I. General information

NPI: 1326919333
Provider Name (Legal Business Name): ANDREA MCCOY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 09/15/2025
Certification Date: 09/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3476 GREGG PLZ APT 3207
BELLEVUE NE
68123-5021
US

IV. Provider business mailing address

12901 S 29TH PL
BELLEVUE NE
68123-3218
US

V. Phone/Fax

Practice location:
  • Phone: 402-707-7327
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number76571
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: