Individual provider Active NPI

Jennifer Denise Kozlica, RN, MPH

  • Community Health Registered Nurse
  • Chattanooga, TN
National Provider Identifier
1003038787
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Registered NurseTaxonomy code 163WC1500X
License
0000124675 Issued in TN
Practice address
540 McCallie Ave
Suite 450
Chattanooga, TN 37402-2089
Phone
(423) 634-5831
Fax
(423) 634-3139
NPI assigned
May 3, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Registered Nurse 163WC1500X 0000124675 TN Primary

Addresses

Primary practice location

540 McCallie Ave
Suite 450
Chattanooga, TN 37402-2089

Mailing address

110 La Porte Dr
Chattanooga, TN 37415-1304
Phone (423) 280-0470

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
0000124675TNMDCommunity Health Registered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1003038787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 LA PORTE DR",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374151304",
            "telephone_number": "423-280-0470",
            "fax_number": "423-634-3139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 MCCALLIE AVE",
            "address_2": "SUITE 450",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374022089",
            "telephone_number": "423-634-5831",
            "fax_number": "423-634-3139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOZLICA",
        "first_name": "JENNIFER",
        "middle_name": "DENISE",
        "credential": "RN, MPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC1500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Community Health",
            "state": "TN",
            "license": "0000124675",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chattanooga, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.