Provider Demographics
NPI:1912986480
Name:JUOZAPAVICIUS, KEVIN PETRONELA (DO, MS, BS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:PETRONELA
Last Name:JUOZAPAVICIUS
Suffix:
Gender:F
Credentials:DO, MS, BS
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Mailing Address - Street 1:1087 STARK RD
Mailing Address - Street 2:APT 5E
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-3537
Mailing Address - Country:US
Mailing Address - Phone:918-510-0116
Mailing Address - Fax:
Practice Address - Street 1:201 INDEPENDENCE
Practice Address - Street 2:COLUMBUS AFB
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39710-5300
Practice Address - Country:US
Practice Address - Phone:662-434-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4305207Q00000X
OH34.010626207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine