Provider Demographics
NPI:1992433320
Name:KOSSEY, NATHAN MICHAEL (PA)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:MICHAEL
Last Name:KOSSEY
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 JEAN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2303
Mailing Address - Country:US
Mailing Address - Phone:517-442-4786
Mailing Address - Fax:
Practice Address - Street 1:3511 JEAN ST
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2303
Practice Address - Country:US
Practice Address - Phone:517-442-4786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program