Provider Demographics
NPI:1639843543
Name:SMITH, KARA ELIZABETH KOZEMZAK (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:ELIZABETH KOZEMZAK
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:ELIZABETH
Other - Last Name:KOZEMZAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5109 SUMMITVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-2858
Mailing Address - Country:US
Mailing Address - Phone:509-907-6300
Mailing Address - Fax:
Practice Address - Street 1:5109 SUMMITVIEW AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-2858
Practice Address - Country:US
Practice Address - Phone:509-907-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61195615363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner