Healthcare Provider Details

I. General information

NPI: 1699414136
Provider Name (Legal Business Name): AUBREY T KOSKI AG-PCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AUBREY T CUTCHIN

II. Dates (important events)

Enumeration Date: 06/02/2022
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 NW 4TH ST
REDMOND OR
97756-1502
US

IV. Provider business mailing address

PO BOX 1517
PENDLETON OR
97801-0410
US

V. Phone/Fax

Practice location:
  • Phone: 541-389-7741
  • Fax: 541-278-8375
Mailing address:
  • Phone: 877-708-1119
  • Fax: 541-278-8349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number0024184471
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberARNP.AP.70138570-NP
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number10035958
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberARNP.AP.70138570-NP
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0024184471
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: