Basic Information
| Provider Information | |||||||||
| NPI: | 1902121577 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COX | ||||||||
| FirstName: | VICTORIA | ||||||||
| MiddleName: | PARK | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 823 DIXON BRANCH RD | ||||||||
| Address2: | |||||||||
| City: | LORETTO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 384692802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9316290010 | ||||||||
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| Practice Location | |||||||||
| Address1: | 325 GERI ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | LAWRENCEBURG | ||||||||
| State: | TN | ||||||||
| PostalCode: | 384642392 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9317629797 | ||||||||
| FaxNumber: | 9317629798 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2010 | ||||||||
| LastUpdateDate: | 04/20/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 175328 | TN | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 14900 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.