Provider Demographics
NPI:1437571031
Name:COSBY, KELLY MCCRIMMON (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:MCCRIMMON
Last Name:COSBY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3027 N CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1179
Mailing Address - Country:US
Mailing Address - Phone:719-776-4646
Mailing Address - Fax:719-776-4640
Practice Address - Street 1:3027 N CIRCLE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1179
Practice Address - Country:US
Practice Address - Phone:719-776-4646
Practice Address - Fax:719-776-4640
Is Sole Proprietor?:No
Enumeration Date:2014-01-16
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-121423363LF0000X
COAPN.0992291-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily