Provider Demographics
NPI:1942411418
Name:COSSETTE, DELORANN (PA C)
Entity Type:Individual
Prefix:MS
First Name:DELORANN
Middle Name:
Last Name:COSSETTE
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:DELORANN
Other - Middle Name:
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1743 SYCAMORE AVE
Mailing Address - Street 2:MOHAVE MENTAL HEALTH CLINIC INC
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409
Mailing Address - Country:US
Mailing Address - Phone:928-757-8111
Mailing Address - Fax:928-757-3256
Practice Address - Street 1:1145 MARINA BLVD
Practice Address - Street 2:MOHAVE MENTAL HEALTH CLINIC INC
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442
Practice Address - Country:US
Practice Address - Phone:928-758-5905
Practice Address - Fax:928-758-8790
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3624363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant