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Individual

CASSANDRA D MC KOY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
9 JORDAN LN, MIDDLETOWN, NY 10940-1603
(845) 699-0263
Mailing address
9 JORDAN LN, MIDDLETOWN, NY 10940-1603
(845) 699-0263

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
273518-1
NY
363LF0000X
Family Nurse Practitioner
Primary
F346767-01
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
02708258
NY
Enumeration date
07/25/2007
Last updated
02/01/2021
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