Provider Demographics
NPI:1598115974
Name:COSGROVE LATIMER, KASSIE J (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KASSIE
Middle Name:J
Last Name:COSGROVE LATIMER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KASSIE
Other - Middle Name:J
Other - Last Name:COSGROVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:314 GOFF MOUNTAIN RD
Mailing Address - Street 2:STE 3
Mailing Address - City:CROSS LANES
Mailing Address - State:WV
Mailing Address - Zip Code:25313-6600
Mailing Address - Country:US
Mailing Address - Phone:304-388-7070
Mailing Address - Fax:
Practice Address - Street 1:314 GOFF MOUNTAIN RD
Practice Address - Street 2:SUITE 3
Practice Address - City:CROSS LANES
Practice Address - State:WV
Practice Address - Zip Code:25313-6602
Practice Address - Country:US
Practice Address - Phone:304-388-7080
Practice Address - Fax:304-388-7090
Is Sole Proprietor?:No
Enumeration Date:2016-06-16
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV83534363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily