Healthcare Provider Details

I. General information

NPI: 1932849213
Provider Name (Legal Business Name): MELANIE KRISTINE KEDDINGTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 W FIREWEED LN STE 100
ANCHORAGE AK
99503-1753
US

IV. Provider business mailing address

1113 W FIREWEED LN STE 100
ANCHORAGE AK
99503-1753
US

V. Phone/Fax

Practice location:
  • Phone: 907-272-2700
  • Fax:
Mailing address:
  • Phone: 907-272-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number188612
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: