Healthcare Provider Details

I. General information

NPI: 1568556926
Provider Name (Legal Business Name): JUDITH ANN KOZICKI ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 12/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 NE 41ST ST SUITE 310
VANCOUVER WA
98662-6791
US

IV. Provider business mailing address

7600 NE 41ST ST SUITE 310
VANCOUVER WA
98662-6791
US

V. Phone/Fax

Practice location:
  • Phone: 360-253-6425
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP30003474
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: