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General NPI Number Information
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NPI Number | 1679925077
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Entity Type | Individual
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Provider Name | KELSEY P COZBY PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/08/2016
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1 HOSPITAL DR DEPT OF EMERGENCY MEDICINE DC029.10
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City | COLUMBIA
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State | MO
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Zip | 65212-1000
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Country | US
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Telephone | 573-884-3386
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Fax |
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Provider Business Mailing Address
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Address Line | 160 TURNBERRY PL APT G
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City | SAINT PETERS
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State | MO
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Zip | 63376-4472
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2016023433
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License Number State | MO
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