Provider Demographics
NPI:1942296744
Name:KOSSICK, MARK A (CRNA)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:KOSSICK
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1459 SAND HILL RD
Mailing Address - Street 2:OFFICE 618
Mailing Address - City:CANDLER
Mailing Address - State:NC
Mailing Address - Zip Code:28715-8943
Mailing Address - Country:US
Mailing Address - Phone:828-670-8810
Mailing Address - Fax:828-670-8816
Practice Address - Street 1:1459 SAND HILL RD
Practice Address - Street 2:OFFICE 618
Practice Address - City:CANDLER
Practice Address - State:NC
Practice Address - Zip Code:28715-8943
Practice Address - Country:US
Practice Address - Phone:828-670-8810
Practice Address - Fax:828-670-8816
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2010-11-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC237443163W00000X
NC036721367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3634832Medicaid
TN36348312Medicare PIN
TN3634832Medicare PIN
NC2618389Medicare PIN