Provider Demographics
NPI:1790572709
Name:KOZIK, ELEXIS NICOLE (RDN, LDN)
Entity type:Individual
Prefix:
First Name:ELEXIS
Middle Name:NICOLE
Last Name:KOZIK
Suffix:
Gender:
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 101
Mailing Address - Street 2:
Mailing Address - City:SAXONBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16056-0101
Mailing Address - Country:US
Mailing Address - Phone:724-575-9243
Mailing Address - Fax:
Practice Address - Street 1:6500 BROOKTREE RD
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9272
Practice Address - Country:US
Practice Address - Phone:724-719-2669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN008968133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered