Basic Information
Provider Information | |||||||||
NPI: | 1700284163 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | COX FAMILY PRACTICE | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1348 | ||||||||
Address2: | 2015 MAIN STREET | ||||||||
City: | HOPE | ||||||||
State: | AR | ||||||||
PostalCode: | 71801 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8707770007 | ||||||||
FaxNumber: | 8707770061 | ||||||||
Practice Location | |||||||||
Address1: | 2015 MAIN STREET | ||||||||
Address2: |   | ||||||||
City: | HOPE | ||||||||
State: | AR | ||||||||
PostalCode: | 71801 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8707770007 | ||||||||
FaxNumber: | 8707770061 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/16/2014 | ||||||||
LastUpdateDate: | 12/16/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | COX | ||||||||
AuthorizedOfficialFirstName: | KIRSTEN | ||||||||
AuthorizedOfficialMiddleName: | KAYE | ||||||||
AuthorizedOfficialTitleorPosition: | FAMILY NURSE PRACTITIONER | ||||||||
AuthorizedOfficialTelephone: | 8707770007 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | ARNP, CNP | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 305R00000X | A004221 | AR | N |   | Managed Care Organizations | Preferred Provider Organization |   | 261QP2300X | A004221 | AR | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.