Provider Demographics
NPI:1487989513
Name:COX, SHAUN PATRICK
Entity type:Individual
Prefix:MR
First Name:SHAUN
Middle Name:PATRICK
Last Name:COX
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:SHAUN
Other - Middle Name:PATRICK
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ANP-BC
Mailing Address - Street 1:209 W PARK ST
Mailing Address - Street 2:
Mailing Address - City:WESTVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61883-1635
Mailing Address - Country:US
Mailing Address - Phone:217-267-3785
Mailing Address - Fax:
Practice Address - Street 1:209 W PARK ST
Practice Address - Street 2:
Practice Address - City:WESTVILLE
Practice Address - State:IL
Practice Address - Zip Code:61883-1635
Practice Address - Country:US
Practice Address - Phone:217-267-3785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002601A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health