Provider Demographics
NPI:1174283212
Name:CODY, VERNON
Entity Type:Individual
Prefix:
First Name:VERNON
Middle Name:
Last Name:CODY
Suffix:
Gender:M
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 23104
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63156-3104
Mailing Address - Country:US
Mailing Address - Phone:314-536-6309
Mailing Address - Fax:314-533-4357
Practice Address - Street 1:509 N TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1810
Practice Address - Country:US
Practice Address - Phone:314-266-9989
Practice Address - Fax:314-536-6309
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health