Provider Demographics
NPI:1740617224
Name:COX, SHELLY JEAN (ACNP)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:JEAN
Last Name:COX
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 NASA PKWY
Mailing Address - Street 2:
Mailing Address - City:SEABROOK
Mailing Address - State:TX
Mailing Address - Zip Code:77586-3215
Mailing Address - Country:US
Mailing Address - Phone:281-532-3160
Mailing Address - Fax:
Practice Address - Street 1:2825 NASA PKWY
Practice Address - Street 2:
Practice Address - City:SEABROOK
Practice Address - State:TX
Practice Address - Zip Code:77586-3215
Practice Address - Country:US
Practice Address - Phone:281-532-3160
Practice Address - Fax:281-532-3480
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP124233363LA2100X
TX675521363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX374482301Medicaid