Provider Demographics
NPI:1659859429
Name:COX, MISTY LEIGH
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:LEIGH
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 1:3500 NORTH ST STE 1C
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-2466
Mailing Address - Country:US
Mailing Address - Phone:936-569-2796
Mailing Address - Fax:
Practice Address - Street 1:3500 NORTH ST STE 1C
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-2466
Practice Address - Country:US
Practice Address - Phone:936-569-2796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician