Provider Demographics
NPI:1174519193
Name:KOSTERS, KAY LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:KAY
Middle Name:LYNN
Last Name:KOSTERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 LINCOLN ST NE
Mailing Address - Street 2:
Mailing Address - City:LE MARS
Mailing Address - State:IA
Mailing Address - Zip Code:51031-3314
Mailing Address - Country:US
Mailing Address - Phone:712-546-3650
Mailing Address - Fax:712-546-3654
Practice Address - Street 1:714 LINCOLN ST NE
Practice Address - Street 2:
Practice Address - City:LE MARS
Practice Address - State:IA
Practice Address - Zip Code:51031-3314
Practice Address - Country:US
Practice Address - Phone:712-546-3650
Practice Address - Fax:712-546-3654
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000967363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA970021534OtherRAILROAD MEDICARE
IAS56153Medicare UPIN