Healthcare Provider Details

I. General information

NPI: 1861262230
Provider Name (Legal Business Name): ABBY MCCOY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date: 07/28/2024
Reactivation Date: 09/10/2024

III. Provider practice location address

7345 COURAGE WAY STE 101
CHATTANOOGA TN
37421-1555
US

IV. Provider business mailing address

7345 COURAGE WAY STE 101
CHATTANOOGA TN
37421-1555
US

V. Phone/Fax

Practice location:
  • Phone: 423-602-9797
  • Fax: 423-602-9796
Mailing address:
  • Phone: 423-602-9797
  • Fax: 423-602-9796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number220239
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number36957
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: