Provider Demographics
NPI:1720209935
Name:KOSHOFER, KATHERINE (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:KOSHOFER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 WELLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-8153
Mailing Address - Country:US
Mailing Address - Phone:662-312-7422
Mailing Address - Fax:
Practice Address - Street 1:400 SUN TEMPLE DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-5924
Practice Address - Country:US
Practice Address - Phone:256-774-5524
Practice Address - Fax:256-774-5523
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5017363A00000X
AL1307363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA412755469AMedicaid
GA412755469AMedicaid
GA97WCJQHMedicare PIN