Healthcare Provider Details

I. General information

NPI: 1174519193
Provider Name (Legal Business Name): KAY LYNN KOSTERS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 LINCOLN ST NE
LE MARS IA
51031-3314
US

IV. Provider business mailing address

714 LINCOLN ST NE
LE MARS IA
51031-3314
US

V. Phone/Fax

Practice location:
  • Phone: 712-546-3650
  • Fax: 712-546-3654
Mailing address:
  • Phone: 712-546-3650
  • Fax: 712-546-3654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number000967
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: