Provider Demographics
NPI:1811028657
Name:COX, JODETTE ELLEN (ARNP)
Entity Type:Individual
Prefix:
First Name:JODETTE
Middle Name:ELLEN
Last Name:COX
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:EUDORA
Mailing Address - State:KS
Mailing Address - Zip Code:66025-9593
Mailing Address - Country:US
Mailing Address - Phone:785-542-2345
Mailing Address - Fax:785-842-1239
Practice Address - Street 1:101 W 10TH ST
Practice Address - Street 2:
Practice Address - City:EUDORA
Practice Address - State:KS
Practice Address - Zip Code:66025-9593
Practice Address - Country:US
Practice Address - Phone:785-542-2345
Practice Address - Fax:785-842-1239
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44937363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS44937OtherARNP LICENSE
MCO629545OtherDEA