Healthcare Provider Details

I. General information

NPI: 1942554787
Provider Name (Legal Business Name): KRISTEN SUSANNAH KOZAK CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN HILEMAN

II. Dates (important events)

Enumeration Date: 11/01/2012
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SOMERSET HOSPITAL 225 SOUTH CENTER AVE
SOMERSET PA
15501
US

IV. Provider business mailing address

3056 MENOHER BLVD
JOHNSTOWN PA
15905-5603
US

V. Phone/Fax

Practice location:
  • Phone: 814-443-5800
  • Fax:
Mailing address:
  • Phone: 814-483-2146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP012885
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: