Provider Demographics
NPI:1285914267
Name:MCCOY, GRETE CALLAN (MPH, RD, CDE)
Entity type:Individual
Prefix:MS
First Name:GRETE
Middle Name:CALLAN
Last Name:MCCOY
Suffix:
Gender:F
Credentials:MPH, RD, CDE
Other - Prefix:
Other - First Name:GRETE
Other - Middle Name:
Other - Last Name:MCBATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3373 MAVIS DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-1445
Mailing Address - Country:US
Mailing Address - Phone:361-947-5383
Mailing Address - Fax:
Practice Address - Street 1:3373 MAVIS DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1445
Practice Address - Country:US
Practice Address - Phone:361-947-5383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT04729133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered