Healthcare Provider Details

I. General information

NPI: 1457986689
Provider Name (Legal Business Name): ANDREW KOST CAA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2020
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4023 REAS LN
NEW ALBANY IN
47150-2228
US

IV. Provider business mailing address

PO BOX 843603
DALLAS TX
75284-3603
US

V. Phone/Fax

Practice location:
  • Phone: 260-436-7875
  • Fax: 260-432-9812
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number75000056A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: