Individual
JACLYN MCCOY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4701 MONTGOMERY BLVD NE, ALBUQUERQUE, NM 87109-1219
(505) 727-7800
Mailing address
12127B N STATE HWY 14 STE 5, CEDAR CREST, NM 87008-9557
(505) 944-9495
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2024-0144
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA2024-0144
STATE LICENSE
NM
Enumeration date
06/22/2023
Last updated
09/02/2025
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