Healthcare Provider Details

I. General information

NPI: 1063346989
Provider Name (Legal Business Name): JENNA MICHELLE KOSYLA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 E HORTON ST
ZEBULON NC
27597-2820
US

IV. Provider business mailing address

7814 BRAEFIELD DR
RALEIGH NC
27616-3315
US

V. Phone/Fax

Practice location:
  • Phone: 919-269-2885
  • Fax: 919-488-1718
Mailing address:
  • Phone: 609-922-9821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number5024590
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: