Provider Demographics
NPI:1326131434
Name:COX, KIM B (APRN)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:B
Last Name:COX
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:MCINTOSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 373
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41314
Mailing Address - Country:US
Mailing Address - Phone:606-593-6023
Mailing Address - Fax:606-593-6023
Practice Address - Street 1:200 MULBERRY STREET
Practice Address - Street 2:SUITE A
Practice Address - City:BOONEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41314
Practice Address - Country:US
Practice Address - Phone:606-596-0701
Practice Address - Fax:606-596-0703
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003257363L00000X, 363LF0000X
KY300257363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78004991Medicaid
KYK067363Medicare PIN
KYK067360Medicare PIN
P20702Medicare UPIN
KY78004991Medicaid
KY0673201Medicare PIN