Provider Demographics
NPI:1700390465
Name:MCCOY, MEGAN LE ANN (MED)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:LE ANN
Last Name:MCCOY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:MISS
Other - First Name:MEGAN
Other - Middle Name:LEANN
Other - Last Name:MALKMUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:3015 MIMOSA LN
Mailing Address - Street 2:
Mailing Address - City:EMMETT
Mailing Address - State:ID
Mailing Address - Zip Code:83617-8002
Mailing Address - Country:US
Mailing Address - Phone:775-781-7496
Mailing Address - Fax:
Practice Address - Street 1:3015 MIMOSA LN
Practice Address - Street 2:
Practice Address - City:EMMETT
Practice Address - State:ID
Practice Address - Zip Code:83617-8002
Practice Address - Country:US
Practice Address - Phone:775-781-7496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-16
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1700390465Medicaid