Healthcare Provider Details

I. General information

NPI: 1548143977
Provider Name (Legal Business Name): TIERNEY KOZAL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2025
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2913 5TH AVE S
FORT DODGE IA
50501-2923
US

IV. Provider business mailing address

2913 5TH AVE S
FORT DODGE IA
50501-2923
US

V. Phone/Fax

Practice location:
  • Phone: 515-955-4440
  • Fax:
Mailing address:
  • Phone: 515-955-4440
  • Fax: 515-955-4449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA186285
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA186285
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: