Provider Demographics
NPI:1780964171
Name:MCCOY, BEVERLY JEAN (STNA)
Entity type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:JEAN
Last Name:MCCOY
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:MISS
Other - First Name:BEVERLY
Other - Middle Name:JEAN
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4054 OKALONA RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-2624
Mailing Address - Country:US
Mailing Address - Phone:216-780-7072
Mailing Address - Fax:
Practice Address - Street 1:4054 OKALONA RD
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-2624
Practice Address - Country:US
Practice Address - Phone:216-780-7072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400630810607376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide