Provider Demographics
NPI:1073819249
Name:HYATT, CAROLYN ANN KOSTER (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:ANN KOSTER
Last Name:HYATT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:CAROLYN
Other - Middle Name:ANN
Other - Last Name:KOSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:104 NEW SPRING CT
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-5245
Mailing Address - Country:US
Mailing Address - Phone:864-871-0448
Mailing Address - Fax:
Practice Address - Street 1:1106 CHUCK DAWLEY BLVD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4183
Practice Address - Country:US
Practice Address - Phone:843-849-1551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-04
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1611363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant