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NPI Code Detail

MEDICARE: MARY JANET COY PA-C, RD

MEDICARE: MARY JANET COY PA-C, RD
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
1363A00000XPhysician AssistantPA030929DC

General Provider Information

NPI Number : 1114902236
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY JANET COY PA-C, RD
Provider Business Mailing Address
First Line : BSC 411 UNIT 28037
Second Line :
City : APO
State : AE
Zip : 09112
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : PSC 411 UNIT 28037
Second Line :
City : APO
State : AE
Zip : 09112
Country : US
Telephone Number : 314-590-2900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2005
Last Update Date : 10/24/2025

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