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General NPI Number Information
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NPI Number | 1235705872
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Entity Type | Individual
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Provider Name | KELLY MCCOY
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Gender | Female
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Dates
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Enumeration Date | 06/03/2021
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 8414 NAAB RD
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City | INDIANAPOLIS
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State | IN
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Zip | 46260-1972
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Country | US
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Telephone | 317-338-7510
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Fax | 317-338-7515
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Provider Business Mailing Address
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Address Line | 8925 N MERIDIAN ST STE 200
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City | INDIANAPOLIS
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State | IN
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Zip | 46260-2385
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Country | US
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Telephone |
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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 | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | MT226575
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 01095886A
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License Number State | IN
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