Basic Information
| Provider Information | |||||||||
| NPI: | 1124392345 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COX | ||||||||
| FirstName: | BRENDA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20172 CROWLEY RIDGE CUTOFF | ||||||||
| Address2: | |||||||||
| City: | HARRISBURG | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724329129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709943103 | ||||||||
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| Practice Location | |||||||||
| Address1: | 20172 CROWLEY RIDGE CUTOFF | ||||||||
| Address2: | |||||||||
| City: | HARRISBURG | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724329129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709943103 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2012 | ||||||||
| LastUpdateDate: | 03/06/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133N00000X | Y | Dietary & Nutritional Service Providers | Nutritionist |
No ID Information.