Healthcare Provider Details

I. General information

NPI: 1871599126
Provider Name (Legal Business Name): CAROL LYNN KLAMSER ANP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 PENNOCK ST
HOMER AK
99603-7223
US

IV. Provider business mailing address

4201 BARTLETT, STE. 201
HOMER AK
99603
US

V. Phone/Fax

Practice location:
  • Phone: 907-226-2228
  • Fax: 907-226-2230
Mailing address:
  • Phone: 907-235-0310
  • Fax: 907-235-0276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number404
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: