Provider Demographics
NPI:1013240688
Name:COX, TABITHA E (PA-C)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:E
Last Name:COX
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 UNDERCLIFF TER
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2176
Mailing Address - Country:US
Mailing Address - Phone:304-327-1890
Mailing Address - Fax:304-325-1908
Practice Address - Street 1:218 UNDERCLIFF TER
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2176
Practice Address - Country:US
Practice Address - Phone:304-327-1890
Practice Address - Fax:304-325-1908
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV475363AM0700X
WV2091363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVPA34021Medicare PIN