Healthcare Provider Details

I. General information

NPI: 1720754161
Provider Name (Legal Business Name): AUSTIN KEITA HUMMEL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 LAKE OTIS PKWY STE 220
ANCHORAGE AK
99508-5230
US

IV. Provider business mailing address

4100 LAKE OTIS PKWY STE 220
ANCHORAGE AK
99508-5230
US

V. Phone/Fax

Practice location:
  • Phone: 907-563-3145
  • Fax: 833-464-5196
Mailing address:
  • Phone: 907-563-3145
  • Fax: 833-464-5196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number246355
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: