Provider Demographics
NPI:1003117458
Name:COX, KATHY LAVERNE (BS)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:LAVERNE
Last Name:COX
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:LAVERNE
Other - Last Name:YANDELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:201 PINNACLE DR SE APT 2912
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87124-0445
Mailing Address - Country:US
Mailing Address - Phone:575-640-7889
Mailing Address - Fax:
Practice Address - Street 1:8915 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87123-2573
Practice Address - Country:US
Practice Address - Phone:505-256-8303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator