Provider Demographics
NPI:1023367208
Name:KOSS, KELLY JO (WHNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:JO
Last Name:KOSS
Suffix:
Gender:F
Credentials:WHNP
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Mailing Address - Street 1:7703 FLOYD CURL DR
Mailing Address - Street 2:MC7977
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3901
Mailing Address - Country:US
Mailing Address - Phone:210-450-9000
Mailing Address - Fax:
Practice Address - Street 1:4502 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4402
Practice Address - Country:US
Practice Address - Phone:210-358-1473
Practice Address - Fax:210-358-4727
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX811550363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX306678901Medicaid
TX306678901Medicaid