Healthcare Provider Details

I. General information

NPI: 1063980316
Provider Name (Legal Business Name): CONNIE B MCCOY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 SW 34TH AVE
AMARILLO TX
79121-1057
US

IV. Provider business mailing address

2000 S MAYS ST STE 201
ROUND ROCK TX
78664-7580
US

V. Phone/Fax

Practice location:
  • Phone: 806-350-7918
  • Fax: 806-418-8982
Mailing address:
  • Phone: 512-244-4272
  • Fax: 806-665-8503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP139633
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: