Provider Demographics
NPI:1437564457
Name:KOSMADAKIS, KELSEY ALANA (NP)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:ALANA
Last Name:KOSMADAKIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:ALANA
Other - Last Name:HUCKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1691 THE ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2203
Mailing Address - Country:US
Mailing Address - Phone:408-795-3619
Mailing Address - Fax:408-287-0405
Practice Address - Street 1:1431 MCHENRY AVE STE 100
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4534
Practice Address - Country:US
Practice Address - Phone:209-574-5905
Practice Address - Fax:209-579-1948
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95030055363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner