Provider Demographics
NPI:1679925077
Name:COZBY, KELSEY P (PA-C)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:P
Last Name:COZBY
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 1:160 TURNBERRY PL APT G
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-4472
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:DEPT OF EMERGENCY MEDICINE DC029.10
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-1000
Practice Address - Country:US
Practice Address - Phone:573-884-3386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016023433363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant