Individual
SAMANTHA LYNN KOSTELAC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
4400 BROADWAY BLVD STE 520, KANSAS CITY, MO 64111-3342
(816) 960-7600
(816) 960-7699
Mailing address
901 E 104TH ST, KANSAS CITY, MO 64131-4517
(816) 960-7600
(816) 960-7699
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
2013017085
MO
163WN0800X
Neuroscience Registered Nurse
2013017085
MO
363LF0000X
Family Nurse Practitioner
Primary
2020022341
MO
363LF0000X
Family Nurse Practitioner
5379596
KS
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/01/2020
Last updated
10/24/2022
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