Provider Demographics
NPI:1578842332
Name:FOX, COLLETTE R (MLP)
Entity Type:Individual
Prefix:
First Name:COLLETTE
Middle Name:R
Last Name:FOX
Suffix:
Gender:F
Credentials:MLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 N DEKALB ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-3911
Mailing Address - Country:US
Mailing Address - Phone:704-482-1482
Mailing Address - Fax:704-480-6012
Practice Address - Street 1:711 N DEKALB ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3911
Practice Address - Country:US
Practice Address - Phone:704-482-1482
Practice Address - Fax:704-480-6012
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005221363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily