Provider Demographics
NPI:1710073218
Name:COX, KATHY D (APRN)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:D
Last Name:COX
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TWIN PORTS CLINIC VA
Mailing Address - Street 2:3520 TOWER AVE.
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880
Mailing Address - Country:US
Mailing Address - Phone:715-398-2469
Mailing Address - Fax:218-728-4404
Practice Address - Street 1:TWIN PORTS CLINIC VA
Practice Address - Street 2:3520 TOWER AVE.
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880
Practice Address - Country:US
Practice Address - Phone:715-398-2469
Practice Address - Fax:218-728-4404
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR0990848163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN060020200Medicaid
MN060020200Medicaid