=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992687495
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY NICOLE COX RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2025
-----------------------------------------------------
Last Update Date | 07/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24091 W LONG LAKE RD
-----------------------------------------------------
City | WILLOW
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99688-0519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-733-2273
-----------------------------------------------------
Fax | 907-733-1735
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1105
-----------------------------------------------------
City | TALKEETNA
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99676-1105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 906-239-0224
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WC0400X
-----------------------------------------------------
Taxonomy Name | Case Management Registered Nurse
-----------------------------------------------------
License Number | 233130
-----------------------------------------------------
License Number State | AK
-----------------------------------------------------