Organization
MEDSUR ONE TELEMEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHLEEN MCCOY NURSE PRACTITION (MANAGER)
(512) 364-2151
Entity
Organization
Contact information
Practice address
110 EISENHOWER COURT (ADMINISTRATIVE OFFICE LOCATION), 1309 COFFEEN AVE STE 1200 SHERIDAN WY 82801, GEORGETOWN, TX 78633
(307) 655-1666
(512) 651-4666
Mailing address
1309 COFFEEN AVENUE STE 1200, SHERIDAN, WY 82801
(307) 655-1666
(512) 651-4666
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
363LG0600X
Gerontology Nurse Practitioner
—
—
Other
Enumeration date
03/18/2020
Last updated
03/18/2020
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