Provider Demographics
NPI:1467578799
Name:COUSINS, JODY ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:JODY
Middle Name:ANN
Last Name:COUSINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6020 RICHMOND HWY
Mailing Address - Street 2:STE 102
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22303-2157
Mailing Address - Country:US
Mailing Address - Phone:443-393-3653
Mailing Address - Fax:877-991-8997
Practice Address - Street 1:1213 24TH STREET
Practice Address - Street 2:SUITE #100
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-2559
Practice Address - Country:US
Practice Address - Phone:360-293-4655
Practice Address - Fax:360-588-1041
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WY7939A207Q00000X
DCMD046860207Q00000X
OH57012332208600000X
MDD0086550207Q00000X
WAMD60132209207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2007259Medicaid