Individual
JORDAN TYLER MCCOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2112 S 49TH ST, OMAHA, NE 68106-3246
(402) 739-4583
Mailing address
2112 S 49TH ST, OMAHA, NE 68106-3246
(402) 739-8059
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
08/29/2014
Last updated
08/29/2014
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