Healthcare Provider Details

I. General information

NPI: 1043172075
Provider Name (Legal Business Name): KC PSYCHIATRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2025
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 S MAIN ST
PITTSTON PA
18640-1705
US

IV. Provider business mailing address

135 S MAIN ST
PITTSTON PA
18640-1705
US

V. Phone/Fax

Practice location:
  • Phone: 570-991-1368
  • Fax:
Mailing address:
  • Phone: 570-991-1368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY COSLETT
Title or Position: MEMBER
Credential: PMHNP-BC
Phone: 570-991-1368