Healthcare Provider Details

I. General information

NPI: 1821171364
Provider Name (Legal Business Name): KIMBERLY D KUBICK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 PIPER ST SUITE U340
ANCHORAGE AK
99508
US

IV. Provider business mailing address

3851 PIPER ST SUITE U340
ANCHORAGE AK
99508
US

V. Phone/Fax

Practice location:
  • Phone: 907-562-0321
  • Fax: 907-562-2683
Mailing address:
  • Phone: 907-562-0321
  • Fax: 907-562-2683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number875
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number24934
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: