Healthcare Provider Details

I. General information

NPI: 1083645998
Provider Name (Legal Business Name): SANDRA JEAN MCCOY RN, CBN, MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDY JEAN MCCOY RN, CBN, MSN, FNP-BC

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 11/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 TEAKWOOD LN STE 300
PLANO TX
75075-4420
US

IV. Provider business mailing address

2101 TEAKWOOD LN STE 300
PLANO TX
75075-4420
US

V. Phone/Fax

Practice location:
  • Phone: 214-396-4916
  • Fax: 972-474-1370
Mailing address:
  • Phone: 214-725-0716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number436534
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP106313
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: