Provider Demographics
NPI:1003480500
Name:COX, CAITLIN TUESDAE
Entity Type:Individual
Prefix:MRS
First Name:CAITLIN
Middle Name:TUESDAE
Last Name:COX
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CAITLIN
Other - Middle Name:TUESDAE
Other - Last Name:COX DILLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1421 NW 185TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-4041
Mailing Address - Country:US
Mailing Address - Phone:405-888-0259
Mailing Address - Fax:
Practice Address - Street 1:4420 N LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-5104
Practice Address - Country:US
Practice Address - Phone:405-425-0421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker