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NPI Code Detail

MEDICARE: SUSAN ELIZABETH MCCOY FNP

MEDICARE: SUSAN ELIZABETH MCCOY FNP
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
1363LF0000XFamily Nurse Practitioner652379TX
2363L00000XNurse PractitionerAP116650TX

Other Identifiers

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

General Provider Information

NPI Number : 1205007309
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN ELIZABETH MCCOY FNP
Provider Business Mailing Address
First Line : 5904 SUMMERFIELD DR
Second Line :
City : TEXARKANA
State : TX
Zip : 75503-4306
Country : US
Telephone Number : 430-200-4350
Fax Number : 866-337-1615
Provider Business Practice Location Address
First Line : 5904 SUMMERFIELD DR
Second Line :
City : TEXARKANA
State : TX
Zip : 75503-4306
Country : US
Telephone Number : 430-200-4350
Fax Number : 866-337-1615
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2008
Last Update Date : 01/27/2025

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