Provider Demographics
NPI:1689045502
Name:COX, AMANDA (RD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:COX
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 PATRICKS CV
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:LA
Mailing Address - Zip Code:71225-9723
Mailing Address - Country:US
Mailing Address - Phone:318-413-1333
Mailing Address - Fax:
Practice Address - Street 1:115 PATRICKS CV
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:LA
Practice Address - Zip Code:71225-9723
Practice Address - Country:US
Practice Address - Phone:318-413-1333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2185133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA458984YJBUMedicare PIN