Individual
MS. ANDREA MCCOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
530 9TH ST, FLORENCE, OR 97439
(541) 997-7104
(541) 997-5975
Mailing address
1115 SE 164TH AVE DEPT 358, VANCOUVER, WA 98683-8004
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA193753
OR
363AS0400X
Surgical Physician Assistant
0074
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1555101
MEDICARE PTAN
—
05
—
30338117
—
NH
05
—
3074644
—
NH
Enumeration date
09/14/2005
Last updated
04/26/2024
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