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General NPI Number Information
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NPI Number | 1700391620
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Entity Type | Individual
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Provider Name | KAITLIN L COX PA
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Gender | Female
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Dates
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Enumeration Date | 12/14/2017
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Last Update Date | 04/25/2019
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Provider Practice Location Address
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Address Line | 777 HOSPITAL WAY STE 300
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City | POCATELLO
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State | ID
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Zip | 83201-5176
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Country | US
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Telephone | 208-232-6100
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Fax | 208-239-3403
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Provider Business Mailing Address
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Address Line | 98 POPLAR ST
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City | BLACKFOOT
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State | ID
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Zip | 83221-1758
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Country | US
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Telephone | 208-232-6100
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Fax | 208-785-8529
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA-1683
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License Number State | ID
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