Organization
ACNE & ROSACEA CLINICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY BETH COX FNP (OWNER)
(731) 668-5000
Entity
Organization
Contact information
Practice address
907 VANN DRIVE SUITE M, JACKSON, TN 38305-6046
(731) 668-5000
(731) 668-5122
Mailing address
907 VANN DRIVE STE M, PO BOX 11537, JACKSON, TN 38012-6046
(731) 668-5000
(731) 668-5122
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APN8135
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3906025
—
TN
Enumeration date
10/21/2008
Last updated
10/21/2008
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