Provider Demographics
NPI:1881867745
Name:KOZEL, JESSICA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ANN
Last Name:KOZEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14425 COLLEGE BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2317
Mailing Address - Country:US
Mailing Address - Phone:913-396-8509
Mailing Address - Fax:913-495-9743
Practice Address - Street 1:14425 COLLEGE BLVD STE 130
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-2317
Practice Address - Country:US
Practice Address - Phone:913-396-8509
Practice Address - Fax:913-495-9745
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-39128207ZD0900X, 207ZP0102X
LA333588207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2011001475OtherMO STATE LICENSE
KS04-39128OtherKS STATE LICENSE
NE272209OtherNE STATE LICENSE