MEDICARE: MEGAN KOSTA FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN.369035-COA1	OH
2	363LF0000X	Family Nurse Practitioner	COA.13755-NP	OH

General Provider Information

NPI Number	:	1912250101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN KOSTA FNP

Provider Business Mailing Address
First Line	:	1020 DENNISON AVE
Second Line	:	SUITE 200
City	:	COLUMBUS
State	:	OH
Zip	:	43201-3497
Country	:	US
Telephone Number	:	614-564-9067
Fax Number	:

Provider Business Practice Location Address
First Line	:	1020 DENNISON AVE
Second Line	:	SUITE 200
City	:	COLUMBUS
State	:	OH
Zip	:	43201-3497
Country	:	US
Telephone Number	:	614-564-9067
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2012
Last Update Date	:	10/25/2012

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