=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841098738
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KOSHA HEALTH & WELLNESS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2025
-----------------------------------------------------
Last Update Date | 03/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 145 ABBIGAIL XING
-----------------------------------------------------
City | TOWNSEND
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19734-2891
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-676-0700
-----------------------------------------------------
Fax | 302-676-0708
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8 THE GRN STE A
-----------------------------------------------------
City | DOVER
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19901-3618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-676-0700
-----------------------------------------------------
Fax | 302-676-0708
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. KRISTEN LYNN HUNT
-----------------------------------------------------
Credential | PMHNP-BC
-----------------------------------------------------
Telephone | 302-676-0700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------