Healthcare Provider Details

I. General information

NPI: 1255722153
Provider Name (Legal Business Name): KATHERINE SHELLEY COX PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE MARIE SHELLEY PA-C

II. Dates (important events)

Enumeration Date: 02/12/2015
Last Update Date: 12/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N91W15750 FALLS PKWY ORTHOPAEDIC SPORTS AND SPINE CENTER
MENOMONEE FALLS WI
53051-2301
US

IV. Provider business mailing address

N91W15750 FALLS PKWY ORTHOPAEDIC SPORTS AND SPINE CENTER
MENOMONEE FALLS WI
53051-2301
US

V. Phone/Fax

Practice location:
  • Phone: 262-532-1100
  • Fax: 262-532-1409
Mailing address:
  • Phone: 262-532-1100
  • Fax: 262-532-1409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3430
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085005390
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: