Healthcare Provider Details

I. General information

NPI: 1649503202
Provider Name (Legal Business Name): KIMBERLY HOFER COX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2009
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 BERTHA RD
MOORCROFT WY
82721-9300
US

IV. Provider business mailing address

PO BOX 325
MOORCROFT WY
82721-0325
US

V. Phone/Fax

Practice location:
  • Phone: 307-299-4017
  • Fax:
Mailing address:
  • Phone: 307-299-4017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: