Provider Demographics
NPI:1275617664
Name:COX, DARRIN L (PA-C)
Entity Type:Individual
Prefix:
First Name:DARRIN
Middle Name:L
Last Name:COX
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:OSKALOOSA
Mailing Address - State:KS
Mailing Address - Zip Code:66066-5359
Mailing Address - Country:US
Mailing Address - Phone:785-863-3417
Mailing Address - Fax:
Practice Address - Street 1:209 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:KS
Practice Address - Zip Code:66066-5359
Practice Address - Country:US
Practice Address - Phone:785-863-3417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00570363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100315820AMedicaid
S45204Medicare UPIN