Provider Demographics
NPI:1639118557
Name:COX, AMANDA J (MPAS PA-C)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:J
Last Name:COX
Suffix:
Gender:F
Credentials:MPAS PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3306 VAIR AVE
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-2610
Mailing Address - Country:US
Mailing Address - Phone:304-771-0384
Mailing Address - Fax:
Practice Address - Street 1:2121 7TH ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-3803
Practice Address - Country:US
Practice Address - Phone:304-485-1721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01084363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1062799OtherNCC PA
WV01084OtherPA NUMBER
WV1062799OtherNCC PA
WVPA23833Medicare ID - Type UnspecifiedPLEASANTS OFFICE
WV01084OtherPA NUMBER
WV1062799OtherNCC PA
WVQ28866Medicare UPIN