Healthcare Provider Details

I. General information

NPI: 1548747256
Provider Name (Legal Business Name): CHRIS KOS PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2018
Last Update Date: 04/15/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5109 NE 82ND AVE STE 215
VANCOUVER WA
98662-6841
US

IV. Provider business mailing address

1308 N KALANI LOOP
RIDGEFIELD WA
98642-7312
US

V. Phone/Fax

Practice location:
  • Phone: 832-840-1604
  • Fax:
Mailing address:
  • Phone: 832-840-1604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1111915
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number947428
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: