Healthcare Provider Details

I. General information

NPI: 1730386293
Provider Name (Legal Business Name): KRISTINA M SMALLEY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 ABBOTT RD STE 101
ANCHORAGE AK
99507-4450
US

IV. Provider business mailing address

3801 LAKE OTIS PKWY STE 300
ANCHORAGE AK
99508-5234
US

V. Phone/Fax

Practice location:
  • Phone: 907-802-1497
  • Fax: 907-339-8786
Mailing address:
  • Phone: 907-562-2277
  • Fax: 907-563-3460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number225667
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: