Healthcare Provider Details

I. General information

NPI: 1316379167
Provider Name (Legal Business Name): KRYSTLE ANN KOSLAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2013
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6051 N FRESNO ST STE 201
FRESNO CA
93710-5280
US

IV. Provider business mailing address

83 E SHAW AVE STE 102 101
FRESNO CA
93710-7616
US

V. Phone/Fax

Practice location:
  • Phone: 559-248-8550
  • Fax: 559-248-8555
Mailing address:
  • Phone: 559-226-0167
  • Fax: 599-226-1559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: