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NPI Code Detail

MEDICARE: IDA J KERNAK BHCA

MEDICARE: IDA J KERNAK BHCA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1172V00000XCommunity Health WorkerAK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205173408
Entity Type Code : Individual
Provider Name (Legal Business Name) : IDA J KERNAK BHCA
Provider Business Mailing Address
First Line : 7033 E TUDOR RD
Second Line :
City : ANCHORAGE
State : AK
Zip : 99507-1262
Country : US
Telephone Number : 907-729-6801
Fax Number : 907-729-5180
Provider Business Practice Location Address
First Line : 225 EAGLE ST
Second Line :
City : ANCHORAGE
State : AK
Zip : 99501-2626
Country : US
Telephone Number : 907-729-6550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2013
Last Update Date : 03/11/2026

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Directions to “ IDA J KERNAK BHCA” Practice Location

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