Healthcare Provider Details

I. General information

NPI: 1396051249
Provider Name (Legal Business Name): KRYSTAL ANNE MOZNY MSN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2010
Last Update Date: 04/28/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 2ND AVE STE 103
SUMMERVILLE SC
29486-7889
US

IV. Provider business mailing address

4975 LACROSS RD STE 150
NORTH CHARLESTON SC
29406-6531
US

V. Phone/Fax

Practice location:
  • Phone: 843-737-9464
  • Fax:
Mailing address:
  • Phone: 843-737-9467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number004423
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22539
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: