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General NPI Number Information
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NPI Number | 1750660163
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Entity Type | Individual
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Provider Name | LINDA TRENETT MCCOY FAMILY NURSE PRACTIT
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Gender | Female
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Dates
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Enumeration Date | 08/16/2011
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Last Update Date | 08/23/2011
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Provider Practice Location Address
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Address Line | 2860 MCDOWELL ROAD EXT
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City | JACKSON
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State | MS
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Zip | 39204-4238
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Country | US
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Telephone | 601-372-1117
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Fax | 601-373-3004
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Provider Business Mailing Address
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Address Line | 109 SHARANNE LANE
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City | BRANDON
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State | MS
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Zip | 39042
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Country | US
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Telephone | 601-672-9370
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Fax | 601-991-2203
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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 | RS61665
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License Number State | MS
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