Provider Demographics
NPI:1568964658
Name:KOSS, KRISTIN MARIE (AGPCNP-BC)
Entity Type:Individual
Prefix:MISS
First Name:KRISTIN
Middle Name:MARIE
Last Name:KOSS
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 N EDGEWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-2100
Mailing Address - Country:US
Mailing Address - Phone:586-698-8686
Mailing Address - Fax:
Practice Address - Street 1:33742 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-3358
Practice Address - Country:US
Practice Address - Phone:248-893-6610
Practice Address - Fax:248-839-6746
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704273147363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner