Healthcare Provider Details

I. General information

NPI: 1982158580
Provider Name (Legal Business Name): HELEN KOZLOV FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2016
Last Update Date: 04/26/2022
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 W CHESTERFIELD BLVD
SPRINGFIELD MO
65807-8686
US

IV. Provider business mailing address

PO BOX 802843
KANSAS CITY MO
64180-2843
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-9060
  • Fax: 417-269-9061
Mailing address:
  • Phone: 417-730-6430
  • Fax: 417-269-7567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2016023919
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: