Healthcare Provider Details

I. General information

NPI: 1326494873
Provider Name (Legal Business Name): TYLER FRANKLIN KOSS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 07/14/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4389 BEAUFORT ROAD
HAVELOCK NC
28532
US

IV. Provider business mailing address

1775 FORRESTAL DR
NORFOLK VA
23551-4600
US

V. Phone/Fax

Practice location:
  • Phone: 252-466-4079
  • Fax:
Mailing address:
  • Phone: 757-836-1552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number0102206885
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number0102206885
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: