Provider Demographics
NPI:1235929829
Name:MCCOY, BENAE (FNP-C)
Entity type:Individual
Prefix:
First Name:BENAE
Middle Name:
Last Name:MCCOY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4149 MEADOW GREEN DR
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-3836
Mailing Address - Country:US
Mailing Address - Phone:419-340-2469
Mailing Address - Fax:
Practice Address - Street 1:4149 MEADOW GREEN DR
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-3836
Practice Address - Country:US
Practice Address - Phone:419-340-2469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704373291363LF0000X
OHAPRNCNP0039017363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily