Provider Demographics
NPI:1861262230
Name:MCCOY, ABBY (NP)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:MCCOY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7345 COURAGE WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-1555
Mailing Address - Country:US
Mailing Address - Phone:423-602-9797
Mailing Address - Fax:423-602-9796
Practice Address - Street 1:7345 COURAGE WAY STE 101
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-1555
Practice Address - Country:US
Practice Address - Phone:423-602-9797
Practice Address - Fax:423-602-9796
Is Sole Proprietor?:No
Enumeration Date:2024-01-05
Last Update Date:2024-09-12
Deactivation Date:2024-07-28
Deactivation Code:
Reactivation Date:2024-09-10
Provider Licenses
StateLicense IDTaxonomies
TN220239163W00000X
TN36957363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse