Provider Demographics
NPI:1619934866
Name:KOSS, JACQUELINE J (CNP)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:J
Last Name:KOSS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1065
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37349-1065
Mailing Address - Country:US
Mailing Address - Phone:931-728-6800
Mailing Address - Fax:931-728-2911
Practice Address - Street 1:1301 MCARTHUR ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-2425
Practice Address - Country:US
Practice Address - Phone:931-728-6800
Practice Address - Fax:931-728-2911
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000007514363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4102275OtherBCBS
TN3348574Medicaid
TN3348575Medicare ID - Type Unspecified
TN4102275OtherBCBS