Basic Information
Provider Information
NPI: 1003295270
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCCOY
FirstName: EUGENIA
MiddleName: KAY
NamePrefix:  
NameSuffix:  
Credential: CRNA, DMPNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 90 JACKSON PIKE
Address2:  
City: GALLIPOLIS
State: OH
PostalCode: 456311560
CountryCode: US
TelephoneNumber: 7404411949
FaxNumber: 7404465982
Practice Location
Address1: 100 JACKSON PIKE
Address2:  
City: GALLIPOLIS
State: OH
PostalCode: 456311560
CountryCode: US
TelephoneNumber: 7404411949
FaxNumber: 7404465982
Other Information
ProviderEnumerationDate: 05/21/2015
LastUpdateDate: 02/12/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000X55911WVN Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 
367500000XAPRN.CRNA.17570OHY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

ID Information
IDTypeStateIssuerDescription
018727705OH MEDICAID


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