Provider Demographics
NPI:1255722153
Name:COX, KATHERINE SHELLEY (PA-C)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:SHELLEY
Last Name:COX
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:MARIE
Other - Last Name:SHELLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:N91W15750 FALLS PKWY
Mailing Address - Street 2:ORTHOPAEDIC SPORTS AND SPINE CENTER
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-2301
Mailing Address - Country:US
Mailing Address - Phone:262-532-1100
Mailing Address - Fax:262-532-1409
Practice Address - Street 1:N91W15750 FALLS PKWY
Practice Address - Street 2:ORTHOPAEDIC SPORTS AND SPINE CENTER
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-2301
Practice Address - Country:US
Practice Address - Phone:262-532-1100
Practice Address - Fax:262-532-1409
Is Sole Proprietor?:No
Enumeration Date:2015-02-12
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3430363AM0700X
IL085005390363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical