Provider Demographics
NPI:1902468457
Name:KOSS, SHIRLEY RYAN (FNP-C)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:RYAN
Last Name:KOSS
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:SHIRLEY
Other - Middle Name:FRANCES
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:171 MAIN ST STE 203B
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01721-1187
Mailing Address - Country:US
Mailing Address - Phone:508-881-3029
Mailing Address - Fax:508-881-1752
Practice Address - Street 1:463 WORCESTER RD STE 104
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-5354
Practice Address - Country:US
Practice Address - Phone:508-650-0010
Practice Address - Fax:508-653-3916
Is Sole Proprietor?:No
Enumeration Date:2019-07-05
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2301202363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily