Provider Demographics
NPI:1871103630
Name:COX, REBECCA LYNN
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:COX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N B AVE
Mailing Address - Street 2:
Mailing Address - City:GRANDFALLS
Mailing Address - State:TX
Mailing Address - Zip Code:79742
Mailing Address - Country:US
Mailing Address - Phone:405-209-4531
Mailing Address - Fax:
Practice Address - Street 1:400 N B AVE
Practice Address - Street 2:
Practice Address - City:GRANDFALLS
Practice Address - State:TX
Practice Address - Zip Code:79742
Practice Address - Country:US
Practice Address - Phone:405-209-4531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX350396164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse