Provider Demographics
NPI:1437591252
Name:KOSORIS, MOLLY DIGAETANO (ACNS-BC)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:DIGAETANO
Last Name:KOSORIS
Suffix:
Gender:F
Credentials:ACNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4316 JAMES CASEY ST
Mailing Address - Street 2:BUILDING A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1116
Mailing Address - Country:US
Mailing Address - Phone:512-623-5300
Mailing Address - Fax:
Practice Address - Street 1:4316 JAMES CASEY ST
Practice Address - Street 2:BUILDING A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1116
Practice Address - Country:US
Practice Address - Phone:512-623-5399
Practice Address - Fax:512-623-5399
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP123910364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health