Healthcare Provider Details

I. General information

NPI: 1669853156
Provider Name (Legal Business Name): CHARITY MCCOY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHARITY PAUL

II. Dates (important events)

Enumeration Date: 06/10/2015
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4966 GLENWAY AVE
CINCINNATI OH
45238-3905
US

IV. Provider business mailing address

4966 GLENWAY AVE
CINCINNATI OH
45238-3905
US

V. Phone/Fax

Practice location:
  • Phone: 513-242-7164
  • Fax: 513-244-2160
Mailing address:
  • Phone: 513-242-7164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3010096
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71006234A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.19008-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: