Healthcare Provider Details

I. General information

NPI: 1245865252
Provider Name (Legal Business Name): AMY MARIE COSMA PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2020
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 BASSWOOD DR
BRISTOL RI
02809-4912
US

IV. Provider business mailing address

11911 BOWER RD
MINERVA OH
44657-9603
US

V. Phone/Fax

Practice location:
  • Phone: 401-655-2031
  • Fax: 937-606-3077
Mailing address:
  • Phone: 330-205-1168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0028291
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number0024186160
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: