Provider Demographics
NPI:1538672290
Name:COX, SHANNA REBECCA JO
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:REBECCA JO
Last Name:COX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 N 11TH ST
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-4525
Mailing Address - Country:US
Mailing Address - Phone:580-475-0148
Mailing Address - Fax:
Practice Address - Street 1:9 N 11TH ST
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-4525
Practice Address - Country:US
Practice Address - Phone:580-475-0148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist