Provider Demographics
NPI:1518226653
Name:MATTOX, CATHY N (RN,MSN,MBA)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:N
Last Name:MATTOX
Suffix:
Gender:F
Credentials:RN,MSN,MBA
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 2146
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:VA
Mailing Address - Zip Code:24151-8446
Mailing Address - Country:US
Mailing Address - Phone:540-420-4299
Mailing Address - Fax:
Practice Address - Street 1:284 MCNEIL MILL RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151-3504
Practice Address - Country:US
Practice Address - Phone:540-819-8346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA00001170205163WC0400X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health