Healthcare Provider Details

I. General information

NPI: 1336850742
Provider Name (Legal Business Name): COSSMEDIC WELLNESS AND AESTHETICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4103 BRIDGEPORT WAY W STE B
UNIVERSITY PLACE WA
98466-4322
US

IV. Provider business mailing address

4103 BRIDGEPORT WAY W STE B
UNIVERSITY PLACE WA
98466-4322
US

V. Phone/Fax

Practice location:
  • Phone: 253-267-0341
  • Fax:
Mailing address:
  • Phone: 253-267-0341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KATHLEEN JEANNETTE RICHARDSON
Title or Position: MEDICAL DIRECTOR
Credential: DNP, FNP-C, ENP-BC
Phone: 253-961-6207