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NPI Code Detail

MEDICARE: KELLY C MCCOY

MEDICARE: KELLY C 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
1101Y00000XCounselor
2172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1104965060
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY C MCCOY
Provider Business Mailing Address
First Line : 1132 GODETIA DR APT 1
Second Line :
City : WOODSIDE
State : CA
Zip : 94062-4117
Country : US
Telephone Number : 650-743-0116
Fax Number :
Provider Business Practice Location Address
First Line : 2000 ALAMEDA DE LAS PULGAS STE 200
Second Line :
City : SAN MATEO
State : CA
Zip : 94403-1293
Country : US
Telephone Number : 650-573-2618
Fax Number : 650-522-9830
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2007
Last Update Date : 06/30/2023

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Directions to “ KELLY C MCCOY ” Practice Location

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