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General NPI Number Information
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NPI Number | 1336850742
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Entity Type | Organization
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Legal Business Name | COSSMEDIC WELLNESS AND AESTHETICS PLLC
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Dates
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Enumeration Date | 12/06/2022
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Last Update Date | 12/06/2022
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Provider Practice Location Address
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Address Line | 4103 BRIDGEPORT WAY W STE B
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98466-4322
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Country | US
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Telephone | 253-267-0341
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Fax |
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Provider Business Mailing Address
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Address Line | 4103 BRIDGEPORT WAY W STE B
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98466-4322
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Country | US
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Telephone | 253-267-0341
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. KATHLEEN JEANNETTE RICHARDSON
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Credential | DNP, FNP-C, ENP-BC
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Telephone | 253-961-6207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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