Healthcare Provider Details

I. General information

NPI: 1497060792
Provider Name (Legal Business Name): KEVIN MICHAEL ISKRA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 08/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 GAFFNEY RD STOP 7440
FT WAINWRIGHT AK
99703-5007
US

IV. Provider business mailing address

1060 GAFFNEY RD# 7440 USA MEDDAC-AK ATTN:MCUC-MMD-QM (CREDENTIALS)
FT. WAINWRIGHT AK
99703-7440
US

V. Phone/Fax

Practice location:
  • Phone: 907-361-5603
  • Fax: 907-361-4847
Mailing address:
  • Phone: 907-361-5603
  • Fax: 907-361-4847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: