1598115974 NPI number — KASSIE J. COSGROVE LATIMER FNP-BC

Table of content: KASSIE J. COSGROVE LATIMER FNP-BC (NPI 1598115974)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598115974 NPI number — KASSIE J. COSGROVE LATIMER FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COSGROVE LATIMER
Provider First Name:
KASSIE
Provider Middle Name:
J.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COSGROVE
Provider Other First Name:
KASSIE
Provider Other Middle Name:
J.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP-BC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1598115974
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
314 GOFF MOUNTAIN RD
Provider Second Line Business Mailing Address:
STE 3
Provider Business Mailing Address City Name:
CROSS LANES
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25313-6600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-388-7070
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
314 GOFF MOUNTAIN RD
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
CROSS LANES
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25313-6602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-388-7080
Provider Business Practice Location Address Fax Number:
304-388-7090
Provider Enumeration Date:
06/16/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  83534 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com