Provider Demographics
NPI:1104040450
Name:COX, JACKIE DENISE (LVN)
Entity Type:Individual
Prefix:MRS
First Name:JACKIE
Middle Name:DENISE
Last Name:COX
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12416 LYRA DR
Mailing Address - Street 2:
Mailing Address - City:WILLIS
Mailing Address - State:TX
Mailing Address - Zip Code:77318-5139
Mailing Address - Country:US
Mailing Address - Phone:936-856-7616
Mailing Address - Fax:
Practice Address - Street 1:19221 INTERSTATE 45 S
Practice Address - Street 2:SUITE 430
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77385-8756
Practice Address - Country:US
Practice Address - Phone:281-419-1464
Practice Address - Fax:281-419-1312
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX150924164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse