Healthcare Provider Details

I. General information

NPI: 1265503742
Provider Name (Legal Business Name): TIMOTHY W ATKINSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 GAFFNEY RD # 7440 COMMANDER, USA-MEDDAC-AK ATTN MCUC-MMD-QM(CREDENTIALS)
FT WAINWRIGHT AK
99703-5001
US

IV. Provider business mailing address

1060 GAFFNEY RD # 7440 COMMANDER, USA-MEDDAC-AK ATTN MCUC-MMD-QM(CREDENTIALS)
FT WAINWRIGHT AK
99703-5001
US

V. Phone/Fax

Practice location:
  • Phone: 907-353-5418
  • Fax: 907-353-4847
Mailing address:
  • Phone: 907-353-5418
  • Fax: 907-353-4847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number260
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberPA 1004563
License Number StateWA

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: