MEDICARE: MS. CIERRA ROSE MCCOY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033729413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CIERRA ROSE MCCOY

Provider Business Mailing Address
First Line	:	125 NASSAU ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45410-1835
Country	:	US
Telephone Number	:	937-694-3175
Fax Number	:

Provider Business Practice Location Address
First Line	:	3936 SADDLE RIDGE CIR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45424-4871
Country	:	US
Telephone Number	:	937-938-5546
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2020
Last Update Date	:	07/31/2020

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