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General NPI Number Information
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NPI Number | 1518712314
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Entity Type | Individual
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Provider Name | TAWANDA LATASHA MCKOY CNAII
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Gender | Female
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Dates
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Enumeration Date | 04/23/2024
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Last Update Date | 04/23/2024
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Provider Practice Location Address
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Address Line | 3011 TOWN CENTER DRIVE STE 130 UNIT #172
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City | FAYETTEVILLE
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State | NC
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Zip | 28306-0049
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Country | US
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Telephone | 833-454-7770
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Fax | 833-454-7770
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Provider Business Mailing Address
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Address Line | 3011 TOWN CENTER DRIVE STE 130 UNIT #172
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City | FAYETTEVILLE
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State | NC
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Zip | 28306-0049
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Country | US
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Telephone | 833-454-7770
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Fax | 833-454-7770
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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 | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 108946
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 6952
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License Number State | NC
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