Individual
MCKENZIE JOY KOSTREVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3801 S NATIONAL AVE, SPRINGFIELD, MO 65807-5210
(417) 269-7728
Mailing address
4042 S HILLCREST AVE APT 202, SPRINGFIELD, MO 65807-6080
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2022048970
MO
Other
Enumeration date
12/21/2022
Last updated
12/21/2022
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