Healthcare Provider Details

I. General information

NPI: 1851094759
Provider Name (Legal Business Name): KELSEY MARIE COOKSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 06/28/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 E CLAY ST
RICHMOND VA
23298-5071
US

IV. Provider business mailing address

301 KARL LINN DR
NORTH CHESTERFIELD VA
23225-6973
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-0996
  • Fax:
Mailing address:
  • Phone: 551-206-2785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number0101288691
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: