Provider Demographics
NPI:1548494511
Name:COXON, JAIME L (RD,LD)
Entity type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:L
Last Name:COXON
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 MARKET ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-6461
Mailing Address - Country:US
Mailing Address - Phone:803-370-1907
Mailing Address - Fax:
Practice Address - Street 1:1012 MARKET ST
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-6461
Practice Address - Country:US
Practice Address - Phone:803-370-1907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-06
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC657133V00000X
NCL003341133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered