Provider Demographics
NPI:1538798368
Name:MCCOY, CASEY (MPH, RDN, CD)
Entity type:Individual
Prefix:MS
First Name:CASEY
Middle Name:
Last Name:MCCOY
Suffix:
Gender:F
Credentials:MPH, RDN, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 SAND POINT WAY NE
Mailing Address - Street 2:M/S OA.5.210 PO BOX 5371
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4800 SAND POINT WAY NE
Practice Address - Street 2:M/S OA.5.210 PO BOX 5371
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98145-5005
Practice Address - Country:US
Practice Address - Phone:206-987-4758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI61029256133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered