Healthcare Provider Details

I. General information

NPI: 1760396584
Provider Name (Legal Business Name): SHELBY JANE KOZAC PARAMEDIC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 COLEMAN RD
PADUCAH KY
42001-9117
US

IV. Provider business mailing address

2119 SPANN LN
PADUCAH KY
42003-9062
US

V. Phone/Fax

Practice location:
  • Phone: 270-443-6529
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number1123486
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: