Healthcare Provider Details

I. General information

NPI: 1376360131
Provider Name (Legal Business Name): KENDRA COX PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 CHICO CT
MONTE VISTA CO
81144-1065
US

IV. Provider business mailing address

1234 COOK AVE
BILLINGS MT
59102-5507
US

V. Phone/Fax

Practice location:
  • Phone: 719-852-9400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: