Provider Demographics
NPI:1194464941
Name:KOSTER, MADISON JANE (PA)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:JANE
Last Name:KOSTER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:JANE
Other - Last Name:SCHMELZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:144 S BLUE BELLS CT
Mailing Address - Street 2:
Mailing Address - City:GARDEN PLAIN
Mailing Address - State:KS
Mailing Address - Zip Code:67050-9225
Mailing Address - Country:US
Mailing Address - Phone:316-680-2531
Mailing Address - Fax:
Practice Address - Street 1:485 N KS HWY 2
Practice Address - Street 2:
Practice Address - City:ANTHONY
Practice Address - State:KS
Practice Address - Zip Code:67003-2526
Practice Address - Country:US
Practice Address - Phone:620-914-1200
Practice Address - Fax:620-914-1259
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program