Provider Demographics
NPI:1639730740
Name:COX, ANTOINESHA TRENAE (LVN)
Entity Type:Individual
Prefix:
First Name:ANTOINESHA
Middle Name:TRENAE
Last Name:COX
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 S JARVIS ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-7605
Mailing Address - Country:US
Mailing Address - Phone:903-619-0201
Mailing Address - Fax:
Practice Address - Street 1:309 S JARVIS ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-7605
Practice Address - Country:US
Practice Address - Phone:903-619-0201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX347175164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse