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General NPI Number Information
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NPI Number | 1366870909
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Entity Type | Organization
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Legal Business Name | TRACI COX GERIATRIC SERVICES PLLC
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Dates
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Enumeration Date | 10/16/2013
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Last Update Date | 10/30/2013
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Provider Practice Location Address
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Address Line | 284 HIGHWAY 9 N
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City | PONTOTOC
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State | MS
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Zip | 38863-1536
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Country | US
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Telephone | 662-296-2451
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Fax |
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Provider Business Mailing Address
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Address Line | 284 HIGHWAY 9 N
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City | PONTOTOC
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State | MS
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Zip | 38863-1536
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Country | US
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Telephone | 662-296-2451
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MRS. TRACI COX
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Credential |
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Telephone | 662-296-2451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | R860656
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License Number State | MS
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