Healthcare Provider Details

I. General information

NPI: 1194688143
Provider Name (Legal Business Name): KAITLIN GRAPENGETER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2025
Last Update Date: 12/06/2025
Certification Date: 12/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 MARIKA RD
FAIRBANKS AK
99709-5521
US

IV. Provider business mailing address

1825 MARIKA RD
FAIRBANKS AK
99709-5521
US

V. Phone/Fax

Practice location:
  • Phone: 907-474-0890
  • Fax: 907-474-3621
Mailing address:
  • Phone: 907-474-0890
  • Fax: 907-474-3621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: