Provider Demographics
NPI:1063123453
Name:COX, KIRSTEN A
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:A
Last Name:COX
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2580 JACKSON AVE W STE 44
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5497
Mailing Address - Country:US
Mailing Address - Phone:662-234-9112
Mailing Address - Fax:662-234-9058
Practice Address - Street 1:499 GLOSTER CREEK VLG STE D1
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4753
Practice Address - Country:US
Practice Address - Phone:662-690-8007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905660363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily