Provider Demographics
NPI:1669976205
Name:COX, MARY (NP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:COX
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 BAKER RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:VA
Mailing Address - Zip Code:24084-3327
Mailing Address - Country:US
Mailing Address - Phone:540-643-2000
Mailing Address - Fax:434-835-4875
Practice Address - Street 1:108 BAKER RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:VA
Practice Address - Zip Code:24084-3327
Practice Address - Country:US
Practice Address - Phone:540-643-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2019-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024175659363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA$$$$$$$$$OtherHAVE NOT APPLIED FOR A MEDICARE NUMBER YET