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NPI Code Detail

MEDICARE: KELLY MCCOY

MEDICARE: KELLY 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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1598424616
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY MCCOY
Provider Business Mailing Address
First Line : 2121 S 125TH EAST AVE STE 106
Second Line :
City : TULSA
State : OK
Zip : 74129-5800
Country : US
Telephone Number : 918-574-8442
Fax Number : 918-591-3955
Provider Business Practice Location Address
First Line : 2121 S 125TH EAST AVE STE 106
Second Line :
City : TULSA
State : OK
Zip : 74129-5800
Country : US
Telephone Number : 918-574-8442
Fax Number : 918-591-3955
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/16/2021
Last Update Date : 12/16/2021

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Directions to “ KELLY MCCOY ” Practice Location

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