Provider Demographics
NPI:1972977106
Name:COX, TAMMY RENA
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:RENA
Last Name:COX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:RENA
Other - Last Name:CENTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:125 WILDCAT DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-8879
Mailing Address - Country:US
Mailing Address - Phone:895-661-0371
Mailing Address - Fax:
Practice Address - Street 1:1859 BYPASS RD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-2713
Practice Address - Country:US
Practice Address - Phone:859-355-1882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-27
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009722363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily