MEDICARE: ZAUNDRA K BASKINS 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	101Y00000X	Counselor	DIAGNOSTICIAN	TX

General Provider Information

NPI Number	:	1083169650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZAUNDRA K BASKINS MCCOY

Provider Business Mailing Address
First Line	:	7901 BONITO DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76002-4118
Country	:	US
Telephone Number	:	682-215-5171
Fax Number	:

Provider Business Practice Location Address
First Line	:	6100 WESTERN PL STE 408
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-4690
Country	:	US
Telephone Number	:	817-735-4165
Fax Number	:

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

Provider Enumeration Date	:	08/23/2016
Last Update Date	:	08/23/2016

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