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Individual

NICHOLE A MCCOY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
APRN-CNP, PMHNP-BC

Contact information

Practice address
188 W HEBBLE AVE, FAIRBORN, OH 45324-4960
(937) 754-5911
Mailing address
PO BOX 3095, DUBLIN, OH 43016-0046

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
0030582
OH
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
0030582
OH
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
LE-00039674
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0030582
OHIO BOARD OF NURSING
OH
01
2021184747
ANCC
OH
01
402430
OHIO BOARD OF NURSING RN
OH
Enumeration date
01/05/2022
Last updated
01/09/2023
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