Provider Demographics
NPI:1871334722
Name:COX, SULLIVAN DALEY (PA-C)
Entity type:Individual
Prefix:
First Name:SULLIVAN
Middle Name:DALEY
Last Name:COX
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 FAWN DR
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1845
Mailing Address - Country:US
Mailing Address - Phone:812-604-5960
Mailing Address - Fax:
Practice Address - Street 1:111 S GREEN RIVER RD STE F
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-7338
Practice Address - Country:US
Practice Address - Phone:812-541-4388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty