Provider Demographics
NPI:1841609146
Name:KOSA, KIMBERLY A (ATC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:KOSA
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 HOPI LN
Mailing Address - Street 2:
Mailing Address - City:TIOGA
Mailing Address - State:PA
Mailing Address - Zip Code:16946-8683
Mailing Address - Country:US
Mailing Address - Phone:716-397-1620
Mailing Address - Fax:
Practice Address - Street 1:11 HOPI LN
Practice Address - Street 2:
Practice Address - City:TIOGA
Practice Address - State:PA
Practice Address - Zip Code:16946-8683
Practice Address - Country:US
Practice Address - Phone:716-397-1620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART004885146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant