Provider Demographics
NPI:1164974572
Name:C A KAZMEROFF PSYCHIATRY, INC
Entity Type:Organization
Organization Name:C A KAZMEROFF PSYCHIATRY, INC
Other - Org Name:CORNERSTONE PSYCHIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE PRACTITIONER, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:KAZMEROFF
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:720-766-8321
Mailing Address - Street 1:19641 E PARKER SQUARE DR STE J
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-7397
Mailing Address - Country:US
Mailing Address - Phone:720-766-8321
Mailing Address - Fax:720-358-5924
Practice Address - Street 1:19641 E PARKER SQUARE DR
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-7399
Practice Address - Country:US
Practice Address - Phone:720-766-8321
Practice Address - Fax:720-358-5924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-01
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0990343-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty