Healthcare Provider Details

I. General information

NPI: 1588650360
Provider Name (Legal Business Name): ANN M KOSS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 W FOREST AVE
JACKSON TN
38301-3942
US

IV. Provider business mailing address

810 W FOREST AVE
JACKSON TN
38301-3942
US

V. Phone/Fax

Practice location:
  • Phone: 731-668-1853
  • Fax: 731-664-7731
Mailing address:
  • Phone: 731-668-1853
  • Fax: 731-664-7731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11034671
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: