Provider Demographics
NPI:1124341805
Name:COX, MISTY (ECDT/MHPP)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:COX
Suffix:
Gender:F
Credentials:ECDT/MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 BALCOM LN
Mailing Address - Street 2:
Mailing Address - City:TRUMANN
Mailing Address - State:AR
Mailing Address - Zip Code:72472-9502
Mailing Address - Country:US
Mailing Address - Phone:870-483-1461
Mailing Address - Fax:
Practice Address - Street 1:1005 BALCOM LN
Practice Address - Street 2:
Practice Address - City:TRUMANN
Practice Address - State:AR
Practice Address - Zip Code:72472-9502
Practice Address - Country:US
Practice Address - Phone:870-483-1461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency