Basic Information
| Provider Information | |||||||||
| NPI: | 1437469830 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOSTER | ||||||||
| FirstName: | RACHEL | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2255 E MOSSY OAKS RD | ||||||||
| Address2: | STE 500 | ||||||||
| City: | SPRING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773891813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082379833 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4650 HAWTHORNE ROAD, | ||||||||
| Address2: | SUITE 3B | ||||||||
| City: | CHUBBUCK | ||||||||
| State: | ID | ||||||||
| PostalCode: | 83202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082379833 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2010 | ||||||||
| LastUpdateDate: | 10/23/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA-867 | ID | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.