Provider Demographics
NPI:1326106527
Name:KOSCIENSKI, WALTER F (DO)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:F
Last Name:KOSCIENSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1292 TWELVE STONES XING
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3345
Mailing Address - Country:US
Mailing Address - Phone:615-851-7711
Mailing Address - Fax:
Practice Address - Street 1:1292 TWELVE STONES XING
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-3345
Practice Address - Country:US
Practice Address - Phone:615-851-7711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02616207R00000X, 207P00000X
TN2100207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64026164Medicaid
KY64026164Medicaid