Individual provider Active NPI

Jalissa Alexandria McCoy, RN

  • Registered Nurse
  • Claremore, OK
National Provider Identifier
1144573874
Registry record updated Sep 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
R 0107116 Issued in OK
Practice address
101 S Moore Ave
Claremore, OK 74017-5047
Phone
(918) 342-6200
Fax
(918) 342-6500
NPI assigned
Oct 18, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X R 0107116 OK Primary

Addresses

Primary practice location

101 S Moore Ave
Claremore, OK 74017-5047

Mailing address

101 S Moore Ave
Claremore, OK 74017-5047
Phone (918) 342-6200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
R 0107116OKMDRegistered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1350518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442016000000",
    "number": "1144573874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 S MOORE AVE",
            "city": "CLAREMORE",
            "state": "OK",
            "postal_code": "740175047",
            "telephone_number": "918-342-6200",
            "fax_number": "918-342-6500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 S MOORE AVE",
            "city": "CLAREMORE",
            "state": "OK",
            "postal_code": "740175047",
            "telephone_number": "918-342-6200",
            "fax_number": "918-342-6500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCOY",
        "first_name": "JALISSA",
        "middle_name": "ALEXANDRIA",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-18",
        "last_updated": "2015-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OK",
            "license": "R 0107116",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Claremore, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.