Healthcare Provider Details

I. General information

NPI: 1740523307
Provider Name (Legal Business Name): KRIS R KILE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2013
Last Update Date: 11/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2741 DEBARR RD 310
ANCHORAGE AK
99508-2992
US

IV. Provider business mailing address

PO BOX 221221
ANCHORAGE AK
99522-1221
US

V. Phone/Fax

Practice location:
  • Phone: 907-677-2990
  • Fax: 907-222-4641
Mailing address:
  • Phone: 907-677-2990
  • Fax: 907-222-4641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1356
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: