Healthcare Provider Details

I. General information

NPI: 1568919611
Provider Name (Legal Business Name): KAYLA TIKIUN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 CALISTA DRIVE
BETHEL AK
99559
US

IV. Provider business mailing address

PO BOX 528 ATTN: BH AHC PROGRAM
BETHEL AK
99559-0528
US

V. Phone/Fax

Practice location:
  • Phone: 907-543-6730
  • Fax: 907-543-6712
Mailing address:
  • Phone: 907-543-6730
  • Fax: 907-543-6712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: