Provider Demographics
NPI:1649219254
Name:KOZEL, JANET S (PA-C)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:S
Last Name:KOZEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8708
Mailing Address - Country:US
Mailing Address - Phone:910-715-5481
Mailing Address - Fax:910-715-5745
Practice Address - Street 1:35 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8708
Practice Address - Country:US
Practice Address - Phone:910-715-5481
Practice Address - Fax:910-715-5745
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000101935363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P86800Medicare UPIN
NC2758048AMedicare ID - Type Unspecified