MEDICARE: TIERNEY KOZAL ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	A186285	IA
2	363L00000X	Nurse Practitioner	A186285	IA

General Provider Information

NPI Number	:	1548143977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIERNEY KOZAL ARNP

Provider Business Mailing Address
First Line	:	2913 5TH AVE S
Second Line	:
City	:	FORT DODGE
State	:	IA
Zip	:	50501-2923
Country	:	US
Telephone Number	:	515-955-4440
Fax Number	:	515-955-4449

Provider Business Practice Location Address
First Line	:	2913 5TH AVE S
Second Line	:
City	:	FORT DODGE
State	:	IA
Zip	:	50501-2923
Country	:	US
Telephone Number	:	515-955-4440
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2025
Last Update Date	:	09/10/2025

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Directions to “ TIERNEY KOZAL ARNP” Practice Location

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