Provider Demographics
NPI:1821272899
Name:KOZMA, MELINDA SUE (NP)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:SUE
Last Name:KOZMA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:SUE
Other - Last Name:THACKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 518
Mailing Address - Street 2:
Mailing Address - City:CLOUDCROFT
Mailing Address - State:NM
Mailing Address - Zip Code:88317
Mailing Address - Country:US
Mailing Address - Phone:734-355-8589
Mailing Address - Fax:
Practice Address - Street 1:2579 SCENIC DR STE B
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-8736
Practice Address - Country:US
Practice Address - Phone:575-446-5600
Practice Address - Fax:575-434-8752
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704184717363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care