Basic Information
Provider Information
NPI: 1134620206
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: COX
FirstName: BRITTANY
MiddleName: JO
NamePrefix: MRS.
NameSuffix:  
Credential: NP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1509 DULLES DR
Address2:  
City: LAFAYETTE
State: LA
PostalCode: 705063718
CountryCode: US
TelephoneNumber: 3379919276
FaxNumber: 3379430846
Practice Location
Address1: 7500 MACCORKLE AVE SE
Address2:  
City: CHARLESTON
State: WV
PostalCode: 253042935
CountryCode: US
TelephoneNumber: 3379919276
FaxNumber: 3379430846
Other Information
ProviderEnumerationDate: 02/23/2018
LastUpdateDate: 03/11/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/11/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XAPRN80810-NP-CWVY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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