Individual
LISA ANN KOSTELECKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(270) 798-8400
Mailing address
155 AIRPORT RD APT 502, CLARKSVILLE, TN 37042-3937
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
—
—
363AM0700X
Medical Physician Assistant
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
09/09/2025
Last updated
09/09/2025
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