Provider Demographics
NPI:1417232018
Name:COX, KEVIN DAVID (FNP)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:DAVID
Last Name:COX
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3943
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-0001
Mailing Address - Country:US
Mailing Address - Phone:919-681-1779
Mailing Address - Fax:919-684-6529
Practice Address - Street 1:2301 ERWIN RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4699
Practice Address - Country:US
Practice Address - Phone:919-681-1779
Practice Address - Fax:919-684-6529
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC193085163W00000X
NC5005374363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC70060Medicaid
NC1417232018OtherCHAMPUS/TRICARE/HEALTHNET #: 1417232018
NCMEDICARE #: NC5619AMedicare UPIN