Provider Demographics
NPI:1992803787
Name:COST, KATHLEEN M (NP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:COST
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:573 HORSE THIEF RUN ROAD
Mailing Address - Street 2:
Mailing Address - City:WELLSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16901-7891
Mailing Address - Country:US
Mailing Address - Phone:570-724-4860
Mailing Address - Fax:
Practice Address - Street 1:573 HORSE THIEF RUN ROAD
Practice Address - Street 2:
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-7891
Practice Address - Country:US
Practice Address - Phone:570-724-4860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP006274C363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC01779120OtherBLUE SHIELD
PAP00268213OtherRR MEDICARE
PAP00268213OtherRR MEDICARE
PAC01779120OtherBLUE SHIELD