Provider Demographics
NPI:1578110649
Name:COX, KELSEY ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:ANN
Last Name:COX
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4625 QUIGG DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-5377
Mailing Address - Country:US
Mailing Address - Phone:707-537-2111
Mailing Address - Fax:707-537-2119
Practice Address - Street 1:4625 QUIGG DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-5377
Practice Address - Country:US
Practice Address - Phone:707-537-2111
Practice Address - Fax:707-537-2119
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56925363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant