Provider Demographics
NPI:1528008893
Name:COX, JENNIFER M (PMHNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:COX
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5665 HALLIE RAE CT
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-8244
Mailing Address - Country:US
Mailing Address - Phone:812-240-4446
Mailing Address - Fax:
Practice Address - Street 1:3512 STELLHORN RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-4631
Practice Address - Country:US
Practice Address - Phone:260-483-9081
Practice Address - Fax:260-483-9196
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001901A363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000525112OtherBLUE CROSS/BLUE SHIELD
IN000000660024OtherANTHEM PIN
IN200935830Medicaid
IN458882748OtherCHAMPUS-TRICARE
INP00288235OtherMEDICARE TRAVELERS RR-GA
IN227700FMedicare ID - Type Unspecified
IN000000525112OtherBLUE CROSS/BLUE SHIELD
INQ47937Medicare UPIN
IN200935830Medicaid