Provider Demographics
NPI:1811394752
Name:KIZZIAR, MASON (APRN-FNP, RNFA, CST)
Entity Type:Individual
Prefix:
First Name:MASON
Middle Name:
Last Name:KIZZIAR
Suffix:
Gender:M
Credentials:APRN-FNP, RNFA, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 S COULTER ST STE B
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-0703
Mailing Address - Country:US
Mailing Address - Phone:806-602-2361
Mailing Address - Fax:806-356-0081
Practice Address - Street 1:1600 S COULTER ST STE B
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-0703
Practice Address - Country:US
Practice Address - Phone:806-602-2361
Practice Address - Fax:806-356-0081
Is Sole Proprietor?:No
Enumeration Date:2014-11-20
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1070127363LF0000X
TX850536163W00000X
TX116194246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist