Provider Demographics
NPI:1942297684
Name:COX, AMANDA DALE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:DALE
Last Name:COX
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 W. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:CROSBYTON
Mailing Address - State:TX
Mailing Address - Zip Code:79322
Mailing Address - Country:US
Mailing Address - Phone:806-272-4524
Mailing Address - Fax:806-272-4749
Practice Address - Street 1:210 DENVER AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:DALHART
Practice Address - State:TX
Practice Address - Zip Code:79022-2731
Practice Address - Country:US
Practice Address - Phone:806-676-5756
Practice Address - Fax:806-244-0036
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX637313363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174093801Medicaid
TX8D4853Medicare ID - Type Unspecified
TX174093801Medicaid