Provider Demographics
NPI:1679702245
Name:COX-PORTER, MICHELLE JILL (PA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JILL
Last Name:COX-PORTER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 N THUNDERBIRD CIR
Mailing Address - Street 2:STE 303
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-1214
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:351 CYPRESS CREEK RD
Practice Address - Street 2:STE 103
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-4528
Practice Address - Country:US
Practice Address - Phone:512-250-8199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-04
Last Update Date:2015-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07834363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0271765OtherSTATE L&I
WAG8896193Medicare PIN