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General NPI Number Information
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NPI Number | 1679719926
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Entity Type | Individual
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Provider Name | KATHLEEN MCCOY NP
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Gender | Female
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Dates
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Enumeration Date | 12/16/2008
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Last Update Date | 02/21/2019
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Provider Practice Location Address
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Address Line | 4500 WILLIAMS DR
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City | GEORGETOWN
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State | TX
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Zip | 78633-1332
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Country | US
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Telephone | 512-688-3854
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Fax | 512-651-4666
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Provider Business Mailing Address
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Address Line | 4500 WILLIAMS DRIVE STATION 212-277 110 EISENHOWER COURT
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City | GEORGETOWN
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State | TX
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Zip | 78633
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Country | US
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Telephone | 512-688-3854
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Fax | 512-651-4666
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0024168104
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | AP119783
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | AP119783
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License Number State | TX
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