Provider Demographics
NPI:1548747256
Name:KOS, CHRIS (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:CHRIS
Middle Name:
Last Name:KOS
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 N KALANI LOOP
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-7312
Mailing Address - Country:US
Mailing Address - Phone:832-840-1604
Mailing Address - Fax:
Practice Address - Street 1:5109 NE 82ND AVE STE 215
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6841
Practice Address - Country:US
Practice Address - Phone:832-840-1604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX947428163W00000X
TX1111915363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse