Provider Demographics
NPI:1841636263
Name:COX, KATY MARY KATHERINE (MD)
Entity type:Individual
Prefix:
First Name:KATY
Middle Name:MARY KATHERINE
Last Name:COX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:KATHERINE
Other - Last Name:BURTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2180 ADA AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-4300
Mailing Address - Country:US
Mailing Address - Phone:501-327-6547
Mailing Address - Fax:501-327-9715
Practice Address - Street 1:2180 ADA AVENUE
Practice Address - Street 2:SUITE 300
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-7203
Practice Address - Country:US
Practice Address - Phone:501-327-6547
Practice Address - Fax:501-327-3478
Is Sole Proprietor?:No
Enumeration Date:2013-05-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013017467207V00000X
ARE10927207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR2231035001Medicaid
ARE10927OtherARKANSAS STATE LICENSE
ARE10927OtherARKANSAS STATE LICENSE