Provider Demographics
NPI:1477208122
Name:KOSIK, CRYSTAL (ARNP-C)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:KOSIK
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 SUZANNA DR
Mailing Address - Street 2:
Mailing Address - City:SELAH
Mailing Address - State:WA
Mailing Address - Zip Code:98942-8761
Mailing Address - Country:US
Mailing Address - Phone:509-607-3898
Mailing Address - Fax:509-607-3898
Practice Address - Street 1:765 SUZANNA DR
Practice Address - Street 2:
Practice Address - City:SELAH
Practice Address - State:WA
Practice Address - Zip Code:98942-8761
Practice Address - Country:US
Practice Address - Phone:509-607-3898
Practice Address - Fax:509-607-3898
Is Sole Proprietor?:No
Enumeration Date:2022-02-21
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00149773163W00000X, 163WP0808X
WAAP61474106363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health