Basic Information
Provider Information | |||||||||
NPI: | 1659762797 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | COX | ||||||||
FirstName: | DOROTHY | ||||||||
MiddleName: | LOUISE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | F.N.P. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | REED | ||||||||
OtherFirstName: | DEE | ||||||||
OtherMiddleName: | L. | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | FNP | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 2303 VILLAGE DR | ||||||||
Address2: |   | ||||||||
City: | SAINT JOSEPH | ||||||||
State: | MO | ||||||||
PostalCode: | 645064954 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8162326818 | ||||||||
FaxNumber: | 8162326823 | ||||||||
Practice Location | |||||||||
Address1: | 2303 VILLAGE DR | ||||||||
Address2: |   | ||||||||
City: | SAINT JOSEPH | ||||||||
State: | MO | ||||||||
PostalCode: | 645064954 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8162326818 | ||||||||
FaxNumber: | 8162326823 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/11/2015 | ||||||||
LastUpdateDate: | 05/08/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 2015003192 | MO | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 77460 | KS | N |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
ID | Type | State | Issuer | Description | 1659762797 | 05 | MO |   | MEDICAID |