Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 2003020311 | MO |
NPI | 1043484371 |
---|---|
Provider Name | Mrs. Michelle Lynn Cox |
First Address | Lake Saint Louis, MO 63367-1382 |
Second Address | Lake Saint Louis, MO 63367-1382 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2008 |
Last Update Date | 29/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
420041212 | (05) | MO |