Provider Demographics
NPI:1578175279
Name:COX, BRENDA LEE
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:LEE
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:PO BOX 692
Mailing Address - Street 2:
Mailing Address - City:COOL RIDGE
Mailing Address - State:WV
Mailing Address - Zip Code:25825-0692
Mailing Address - Country:US
Mailing Address - Phone:304-890-5299
Mailing Address - Fax:
Practice Address - Street 1:260 TOLLIVER ST
Practice Address - Street 2:
Practice Address - City:GHENT
Practice Address - State:WV
Practice Address - Zip Code:25843
Practice Address - Country:US
Practice Address - Phone:304-890-5299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant