Healthcare Provider Details

I. General information

NPI: 1083812671
Provider Name (Legal Business Name): VIOLA MCKOY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22125 17TH AVE S.E
BOHELL WA
90821-7406
US

IV. Provider business mailing address

5825 BRETT DR
FORT KNOX KY
40121-2059
US

V. Phone/Fax

Practice location:
  • Phone: 254-697-9003
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number968878
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: