Provider Demographics
NPI:1205218112
Name:WILLCOX, KATHLEEN QUINN (DO)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:QUINN
Last Name:WILLCOX
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MISS
Other - First Name:KATHLEEN
Other - Middle Name:QUINN
Other - Last Name:O'NEILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:MOUNT AYR MEDICAL CLINIC
Mailing Address - Street 2:504 N. CLEVELAND ST
Mailing Address - City:MOUNT AYR
Mailing Address - State:IA
Mailing Address - Zip Code:50854
Mailing Address - Country:US
Mailing Address - Phone:641-464-3226
Mailing Address - Fax:641-464-4476
Practice Address - Street 1:MOUNT AYR MEDICAL CLINIC
Practice Address - Street 2:504 N. CLEVELAND ST
Practice Address - City:MOUNT AYR
Practice Address - State:IA
Practice Address - Zip Code:50854
Practice Address - Country:US
Practice Address - Phone:641-464-3226
Practice Address - Fax:641-464-4476
Is Sole Proprietor?:No
Enumeration Date:2015-06-26
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015017596207Q00000X
IADO-05187207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine