Provider Demographics
NPI:1154603611
Name:COX, WIMBERLY TIPPING (NP)
Entity type:Individual
Prefix:
First Name:WIMBERLY
Middle Name:TIPPING
Last Name:COX
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 211699
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-3699
Mailing Address - Country:US
Mailing Address - Phone:866-849-0692
Mailing Address - Fax:
Practice Address - Street 1:220 N MAIN ST STE 500
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-2129
Practice Address - Country:US
Practice Address - Phone:866-849-0692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0038259363LG0600X
IN71016589A363LG0600X
SC17573363LG0600X
PASP032777363LG0600X
TN37914363LG0600X
MO2025002114363LG0600X
KY4033745363LG0600X
AL3-002082363LG0600X
AZ306051363LG0600X
COC-APN.0101894-C-NP363LG0600X
FLAPRN11036998363LG0600X
GAGAA-NP003236363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1944Medicaid
SCAA77817951Medicare PIN