MEDICARE: KAMI LYN FOX CNP

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	363LP0200X	Pediatric Nurse Practitioner	NP-08822	OH

General Provider Information

NPI Number	:	1760430490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAMI LYN FOX CNP

Provider Business Mailing Address
First Line	:	1010 HAGER ST
Second Line	:
City	:	ST MARYS
State	:	OH
Zip	:	45885-2421
Country	:	US
Telephone Number	:	419-394-2610
Fax Number	:	419-394-6605

Provider Business Practice Location Address
First Line	:	1010 HAGER ST
Second Line	:
City	:	ST MARYS
State	:	OH
Zip	:	45885-2421
Country	:	US
Telephone Number	:	419-394-2610
Fax Number	:	419-394-6605

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	07/08/2007

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