Rekita Dechelle McCoy, NURSE PRACTITIONER

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

902513 Issued in MS

Practice address

200 Riverwind Dr Ste 104
Pearl, MS 39208-5652

Phone

(601) 345-4044

NPI assigned

Feb 19, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fast Pace Mississippi, PLLC

  • Rural Health Clinic/Center
  • Ripley, MS
  • NPI 1447769559

  Nurse Practitioner

  Medicare reassignment NPD
• Community Care Health Network LLC

  • Nurse Practitioner
  • Nashville, TN
  • NPI 1619368842

  MS

  Medicare reassignment NPD
• Fast Pace Mississippi, PLLC

  • Rural Health Clinic/Center
  • Kosciusko, MS
  • NPI 1851050579
  NPD

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

{
    "created_epoch": "1518998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662163200000",
    "number": "1215437058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 RIVERWIND DR STE 104",
            "city": "PEARL",
            "state": "MS",
            "postal_code": "392085652",
            "telephone_number": "601-345-4044",
            "fax_number": "601-510-9334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 RIVERWIND DR STE 104",
            "city": "PEARL",
            "state": "MS",
            "postal_code": "392085652",
            "telephone_number": "601-345-4044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCOY",
        "first_name": "REKITA",
        "middle_name": "DECHELLE",
        "name_prefix": "Ms.",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-19",
        "last_updated": "2022-09-03",
        "certification_date": "2022-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "MCCO-RFN3U1",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "F01180598",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "902513",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MS",
            "license": "902513",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "902513",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1215437058",
            "state": "MS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.divinitypediatricclinic.com",
            "affiliation": "N",
            "endpointDescription": "business website",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "200 Riverwind Dr Ste 104",
            "city": "Pearl",
            "state": "MS",
            "country_code": "US",
            "postal_code": "392085652",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Nancy Sharon Martin, M.D.
• Christopher Hamilton Mathews, DMD
• Alisha Shanell Matthews
• Maxem Health Urgent Care Pearl
• Elizabeth McCord, FNP-C SANE-A SANE-P
• Stephanie McElroy-Liddell, PHARM D
• Doris McGee
• Katrina K McHuley
• Franchesca J McKnight
• Shakelia K McLaurin

• Family Nurse Practitioner in Pearl, MS
• Providers in Pearl, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.