Healthcare Provider Details

I. General information

NPI: 1225885478
Provider Name (Legal Business Name): KIM KOZAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 05/06/2024
Certification Date: 05/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 BROAD ST
JOHNSTOWN PA
15906-2745
US

IV. Provider business mailing address

401 BROAD ST
JOHNSTOWN PA
15906-2745
US

V. Phone/Fax

Practice location:
  • Phone: 814-535-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN573126
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: