MEDICARE: KATELYN COX LM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	176B00000X	Midwife	99575	TX

General Provider Information

NPI Number	:	1578380614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYN COX LM

Provider Business Mailing Address
First Line	:	4743 JOHNSON CREEK LOOP
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-3890
Country	:	US
Telephone Number	:	979-349-9565
Fax Number	:

Provider Business Practice Location Address
First Line	:	4743 JOHNSON CREEK LOOP
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-3890
Country	:	US
Telephone Number	:	979-349-9565
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2024
Last Update Date	:	09/20/2024

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Directions to “ KATELYN COX LM” Practice Location

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