Healthcare Provider Details

I. General information

NPI: 1750626503
Provider Name (Legal Business Name): NICOLE MCCOY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2012
Last Update Date: 09/07/2025
Certification Date: 09/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 W MARKET ST STE 10
AKRON OH
44313-7033
US

IV. Provider business mailing address

1650 W MARKET ST STE 10
AKRON OH
44313-7033
US

V. Phone/Fax

Practice location:
  • Phone: 330-634-6163
  • Fax:
Mailing address:
  • Phone: 330-634-6163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN444028
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: