Provider Demographics
NPI:1316532096
Name:COX, KATHRYN DOOLEY
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:DOOLEY
Last Name:COX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 HARRIS ROAD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:MS
Mailing Address - Zip Code:39039
Mailing Address - Country:US
Mailing Address - Phone:662-590-2391
Mailing Address - Fax:
Practice Address - Street 1:1050 RIVER OAKS DRIVE
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232
Practice Address - Country:US
Practice Address - Phone:601-420-0134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2022-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS913353163W00000X
MS905610363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse