Provider Demographics
NPI:1417109158
Name:MCDIVITT-COX, ALISSA D (FNP-C, MS)
Entity Type:Individual
Prefix:MRS
First Name:ALISSA
Middle Name:D
Last Name:MCDIVITT-COX
Suffix:
Gender:F
Credentials:FNP-C, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47346-1304
Mailing Address - Country:US
Mailing Address - Phone:765-969-3767
Mailing Address - Fax:
Practice Address - Street 1:251 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:IN
Practice Address - Zip Code:47346-1304
Practice Address - Country:US
Practice Address - Phone:765-969-3767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002973A363LF0000X
OHCOA.10035-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000709399OtherANTHEM
IN200997530Medicaid
IN940940C8Medicare PIN