Healthcare Provider Details

I. General information

NPI: 1073303525
Provider Name (Legal Business Name): SANDRA GAIL MCCOY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA THORNSBURY

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1754 US HIGHWAY 23 NORTH
WEBER CITY VA
24290-7071
US

IV. Provider business mailing address

PO BOX 9
KINGSPORT TN
37662-0009
US

V. Phone/Fax

Practice location:
  • Phone: 276-386-5980
  • Fax: 276-386-5995
Mailing address:
  • Phone: 423-857-2066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001301975
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024193625
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: