Provider Demographics
NPI:1942554787
Name:KOZAK, KRISTEN SUSANNAH (CRNP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:SUSANNAH
Last Name:KOZAK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:HILEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3056 MENOHER BLVD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-5603
Mailing Address - Country:US
Mailing Address - Phone:814-483-2146
Mailing Address - Fax:
Practice Address - Street 1:SOMERSET HOSPITAL
Practice Address - Street 2:225 SOUTH CENTER AVE
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501
Practice Address - Country:US
Practice Address - Phone:814-443-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-01
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012885363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1942554787Medicaid