Provider Demographics
NPI:1083991160
Name:COX, BRANDI LYNN
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:LYNN
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:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-509-8888
Mailing Address - Fax:
Practice Address - Street 1:3802 MANHATTON DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-9451
Practice Address - Country:US
Practice Address - Phone:903-509-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX629397363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75-2616977-007OtherTRICARE
TX75-2771569-005OtherTRICARE
TX867N69OtherBCBS
TX75-2616977-028OtherTRICARE
TX752616977020OtherTRICARE
TXP01635816OtherRAIL ROAD MEDICARE
TX75-0818167-022OtherTRICARE
TX8180NVOtherBCBS
TX895N70OtherBCBS
TXP01154590OtherRAIL ROAD
TX288776204Medicaid
TXP01635816OtherRAIL ROAD MEDICARE
TX75-0818167-022OtherTRICARE
TXTXB141853Medicare Oscar/Certification