=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265151237
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGARY ROSE MCCOY CRNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2022
-----------------------------------------------------
Last Update Date | 01/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 S 11TH ST BLDG SUITE607
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19107-4824
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-955-6996
-----------------------------------------------------
Fax | 215-955-6010
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2011 DOGWOOD LN
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19810-3606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-757-1796
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | RN694849
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | SP026544
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------