Provider Demographics
NPI:1588948806
Name:COX, MANDY LYNN (PAC)
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:LYNN
Last Name:COX
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 BIRMINGHAM RD STE 100
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-4063
Mailing Address - Country:US
Mailing Address - Phone:979-703-1902
Mailing Address - Fax:979-703-6104
Practice Address - Street 1:1730 BIRMINGHAM RD STE 100
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-4063
Practice Address - Country:US
Practice Address - Phone:979-703-1902
Practice Address - Fax:979-703-6104
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04297363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGMedicaid
TXPENDINGMedicare PIN