Individual
MS. REKITA DECHELLE MCCOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
200 RIVERWIND DR STE 104, PEARL, MS 39208-5652
(601) 345-4044
Mailing address
200 RIVERWIND DR STE 104, PEARL, MS 39208-5652
(601) 345-4044
(601) 510-9334
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
F01180598
MS
207Q00000X
Family Medicine Physician
MCCO-RFN3U1
MS
363L00000X
Nurse Practitioner
902513
MS
363LF0000X
Family Nurse Practitioner
Primary
902513
MS
363LP0200X
Pediatric Nurse Practitioner
902513
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1215437058
—
MS
Enumeration date
02/19/2018
Last updated
09/03/2022
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