KELLIE A COSSEBOOM (NPI# 1750364626) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750364626 |
| Entity Type | Individual |
| Full Name | KELLIE A COSSEBOOM |
| Credential | AMD |
| Practice Address |
758 Kapahulu Ave A-319 Honolulu HI 96816-1196 |
| Mailing Address |
277 Ohua Ave Honolulu HI 96815-3643 |
| Practice Telephone | 8089224787 |
| Practice Fax Number | 8089224950 |
| Mailing Telephone | 8089224787 |
| Mailing Fax Number | 8089224950 |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | AMD 160 | HI | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| HI | 497603-01 | 05 | |
| HI | ALOHA CARE | 497603-01 | 01 |
| Street Address |
758 KAPAHULU AVE A-319 |
| City | HONOLULU |
| State | HI |
| Zip Code | 96816-1196 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598370439 | Marina Nogues | Nurse Practitioner | 3901b Maunahilu Pl, Honolulu, HI 96816 | 2020-09-08 |
| 1184272007 | Gwen Mikasa | Speech-Language Pathologist | Office of Student Support Medicaid Reimbursement, 475 22nd Ave, Bldg 302, Room 101, Honolulu, HI 96816 | 2019-09-04 |
| 1467009290 | Abigail Hobbs | Occupational Therapist | 475 22nd Ave, Building 302, Rm. 101, Oss, Honolulu, HI 96816 | 2019-08-26 |
| 1588210587 | Mona Ann Hiyoto Akina | Speech-Language Pathologist | 475 2nd Ave., Room 127, Honolulu, HI 96816 | 2019-08-15 |
| 1356996599 | Karen Amanda Kama | Speech-Language Pathologist | Office of Student Support Services, 475 22nd Avenue Room 101, Honolulu, HI 96816 | 2019-08-05 |
| 1043864630 | Brittni Holt | Speech-Language Pathologist | 475 22nd Ave Building 302 Room 101, Honoluu, HI 96816 | 2019-07-31 |
| 1376197962 | Mallory Register | Speech-Language Pathologist | 475 22nd Avenue, Building 302, Room 101, Honolulu, HI 96816 | 2019-07-31 |
| 1588144935 | Mihoko Yacavone | Dietitian, Registered | 833 15th Ave, Honolulu, HI 96816 | 2018-08-15 |
| 1760976013 | Orthopaedic Specialists Hawaii LLC | Orthopaedic Surgery | 4348 Waialae Ave, Suite 479, Honolulu, HI 96816 | 2018-06-20 |
| 1790207389 | Richard Todd Robbins Jr. | Behavior Technician | 200 N. Vineyard Blvd. Suite A-600, Honolulu, HI 96816 | 2017-07-14 |
| Find all providers in zip 96816 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205433505 | Jessica Renae Hall | Physician Assistant | 201 Bougainvillea Loop, Honolulu, HI 96818-1495 | 2020-10-08 |
| 1568076685 | Emily Rose Callaway | Physician Assistant | 501 Hahaione St Apt 8j, Honolulu, HI 96825-1444 | 2020-09-04 |
| 1982161782 | Amanda Laurent | Physician Assistant | 1401 S Beretania St Ste 102, Honolulu, HI 96814-1871 | 2019-02-28 |
| 1720578693 | Ashley Marie Mccall | Physician Assistant | 900 Fort Street Mall Ste 1040, Honolulu, HI 96813-3701 | 2018-05-15 |
| 1154835353 | Arthur Burgos Domingo | Physician Assistant | 445 Seaside Ave, Honolulu, HI 96815-2640 | 2017-11-27 |
| 1922400142 | Kumiko Imai | Physician Assistant | 1456 Thurston Ave, Apt1104, Honolulu, HI 96822-3682 | 2014-09-18 |
| 1447694179 | Christopher Henry Rossetti | Physician Assistant | 1253 Makalapa Road, Honolulu, HI 96817 | 2013-04-24 |
| 1003150368 | Mandi Sue Breyman | Physician Assistant | 1329 Lusitana St Ste 202, Honolulu, HI 96813-2401 | 2012-11-26 |
| 1831336817 | Isabel Dorotea Hung Wan | Physician Assistant | 550 S. Beretania St., #405, Honolulu, HI 96813 | 2009-01-13 |
| 1437308111 | Kathleen Louise Elliott | Physician Assistant | 2045 Alaeloa St, Honolulu, HI 96821-1020 | 2008-09-17 |
| Find all providers in HONOLULU | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.