Basic Information
Provider Information
NPI: 1477076487
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KOST
FirstName: BRANDI
MiddleName: E
NamePrefix:  
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2700 STANLEY GAULT PKWY STE 129
Address2:  
City: LOUISVILLE
State: KY
PostalCode: 402235176
CountryCode: US
TelephoneNumber: 2703263949
FaxNumber: 2703263954
Practice Location
Address1: 1200 BRECKENRIDGE ST
Address2:  
City: OWENSBORO
State: KY
PostalCode: 423031089
CountryCode: US
TelephoneNumber: 2706858672
FaxNumber: 2706858230
Other Information
ProviderEnumerationDate: 07/21/2017
LastUpdateDate: 05/09/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/06/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X3011410KYY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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