Healthcare Provider Details

I. General information

NPI: 1235157918
Provider Name (Legal Business Name): KATHLEEN MCCOY DNSC, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

446 METROPLEX DR SUITE 1A
NASHVILLE TN
37211-3139
US

IV. Provider business mailing address

3919 PLANTATION DR
COOKEVILLE TN
38506-6101
US

V. Phone/Fax

Practice location:
  • Phone: 615-781-0013
  • Fax:
Mailing address:
  • Phone: 931-537-2267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number6797
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: