Provider Demographics
NPI:1174014484
Name:KOSMAN, KYLE (RN)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:KOSMAN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9122 NW WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-2239
Mailing Address - Country:US
Mailing Address - Phone:515-505-9011
Mailing Address - Fax:
Practice Address - Street 1:9122 NW WINDSOR DR
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-2239
Practice Address - Country:US
Practice Address - Phone:515-505-9011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-22
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA127959163W00000X
IAA127959363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty