Provider Demographics
NPI:1316129745
Name:COX, KATIE B (LPN)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:B
Last Name:COX
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 CHESTNUT ST
Mailing Address - Street 2:C21
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-3080
Mailing Address - Country:US
Mailing Address - Phone:607-319-0922
Mailing Address - Fax:
Practice Address - Street 1:143 CHESTNUT ST
Practice Address - Street 2:C21
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-3080
Practice Address - Country:US
Practice Address - Phone:607-319-0922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271800164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse