Provider Demographics
NPI:1073680591
Name:COX, REGINA NANNETTE
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:NANNETTE
Last Name:COX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6618 BAY CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-9109
Mailing Address - Country:US
Mailing Address - Phone:865-688-7506
Mailing Address - Fax:865-688-4545
Practice Address - Street 1:6618 BAY CIRCLE DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-9109
Practice Address - Country:US
Practice Address - Phone:865-688-7506
Practice Address - Fax:865-688-4545
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4019864OtherBLUECROSS BLUESHIELD
TN1454248Medicaid
TN4019864OtherBLUECROSS BLUESHIELD