Provider Demographics
NPI:1588673925
Name:KAZLO, KELLY (APRN-BC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:KAZLO
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DAYTON VETERANS AFFAIRS
Mailing Address - Street 2:4100 W THIRD STREET MAIL STOP 116
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45428
Mailing Address - Country:US
Mailing Address - Phone:937-268-6511
Mailing Address - Fax:
Practice Address - Street 1:DAYTON VETERANS AFFAIRS
Practice Address - Street 2:4100 W THIRD STREET MAIL STOP 116
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45428
Practice Address - Country:US
Practice Address - Phone:937-268-6511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR126942363L00000X, 163WP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health