Healthcare Provider Details

I. General information

NPI: 1477208122
Provider Name (Legal Business Name): CRYSTAL KOSIK ARNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2022
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 SUZANNA DR
SELAH WA
98942-8761
US

IV. Provider business mailing address

765 SUZANNA DR
SELAH WA
98942-8761
US

V. Phone/Fax

Practice location:
  • Phone: 509-607-3898
  • Fax: 509-607-3898
Mailing address:
  • Phone: 509-607-3898
  • Fax: 509-607-3898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61474106
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61474106
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00149773
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN00149773
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: