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General NPI Number Information
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NPI Number | 1134616733
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Entity Type | Individual
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Provider Name | RANDALL MATTHEW MCCOY MSN, RN, CNS-AG
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Gender | Male
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Dates
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Enumeration Date | 04/18/2018
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Last Update Date | 04/18/2018
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Provider Practice Location Address
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Address Line | 1400 8TH AVE
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City | FORT WORTH
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State | TX
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Zip | 76104-4110
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Country | US
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Telephone | 817-926-2544
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1291
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City | WEATHERFORD
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State | TX
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Zip | 76086-1291
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Country | US
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Telephone | 325-451-0600
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number | AP136405
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License Number State | TX
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