Provider Demographics
NPI:1598756116
Name:COX, JUDY ALICE (MS RD LD)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:ALICE
Last Name:COX
Suffix:
Gender:F
Credentials:MS RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 MITCHELL SUITE #4
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-4618
Mailing Address - Country:US
Mailing Address - Phone:575-935-9557
Mailing Address - Fax:579-356-9558
Practice Address - Street 1:1500 MITCHELL ST
Practice Address - Street 2:SUITE 4
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-4613
Practice Address - Country:US
Practice Address - Phone:575-935-9557
Practice Address - Fax:575-935-9558
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2013-05-16
Deactivation Date:2008-10-28
Deactivation Code:
Reactivation Date:2013-02-06
Provider Licenses
StateLicense IDTaxonomies
NM249133V00000X
TXDT03954133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM75523728Medicaid
VAD000Medicare UPIN
P53027Medicare UPIN
NM75523728Medicaid