Provider Demographics
NPI:1578886941
Name:KOSMOWSKI, JESSICA G (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:G
Last Name:KOSMOWSKI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:M
Other - Last Name:GILBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:101 PRINCETON DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31220-8739
Mailing Address - Country:US
Mailing Address - Phone:478-737-0344
Mailing Address - Fax:
Practice Address - Street 1:610 3RD ST
Practice Address - Street 2:SUITE 206
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-3294
Practice Address - Country:US
Practice Address - Phone:478-464-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-12
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN170482367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00819053OtherRAILROAD MEDICARE
GA580628385OtherTRICARE
GA466646813AMedicaid
GA202I438673Medicare PIN