Healthcare Provider Details

I. General information

NPI: 1457735144
Provider Name (Legal Business Name): KRISTEN NICOLE BOZARTH FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2015
Last Update Date: 07/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 LAMPLIGHTER ROAD
OAK HILL WV
25901
US

IV. Provider business mailing address

PO BOX 40
OAK HILL WV
25901
US

V. Phone/Fax

Practice location:
  • Phone: 304-877-8783
  • Fax: 304-465-6860
Mailing address:
  • Phone: 304-877-8783
  • Fax: 304-465-6860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2014023070
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number79023
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: