Provider Demographics
NPI:1669877718
Name:COZBY, JODI LYNN (FNP - C)
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:LYNN
Last Name:COZBY
Suffix:
Gender:F
Credentials:FNP - C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:DEER LODGE
Mailing Address - State:MT
Mailing Address - Zip Code:59722-1534
Mailing Address - Country:US
Mailing Address - Phone:406-846-1178
Mailing Address - Fax:406-496-6035
Practice Address - Street 1:500 CONLEY LAKE RD
Practice Address - Street 2:
Practice Address - City:DEER LODGE
Practice Address - State:MT
Practice Address - Zip Code:59722-8709
Practice Address - Country:US
Practice Address - Phone:406-415-6212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-31
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MT101207363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program