Doctor Name: | MRS. MAMIE M KOSKO |
NPI Number: | 1104107036 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | R872464 |
Business Practice Address: | 100 Wilburn Way Starkville, MS - 397593692 |
Business Phone Number: | 6623204008 |
Business Fax Number: | 6623202450 |
Mailing Address: | 100 Wilburn Way, STARKVILLE |
State: | MS |
Postal Code: | 397593692 |
Phone Number: | 6623204008 |
Fax Number: | 6623202450 |
NPI Enumeration Date: | 09/06/2011 |
NPI Last Update Date: | 02/24/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R872464 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |