Basic Information
| Provider Information | |||||||||
| NPI: | 1235195553 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COX | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 66 N PAULINE ST | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381055105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9014487642 | ||||||||
| FaxNumber: | 9014488015 | ||||||||
| Practice Location | |||||||||
| Address1: | 1910 NONCONNAH BLVD | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381322113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9014482300 | ||||||||
| FaxNumber: | 9014486657 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 10960 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 00757821 | 05 | MS | MEDICAID | 4068128 | 01 | TN | BC/BS TN | OTHER |