Healthcare Provider Details

I. General information

NPI: 1568027159
Provider Name (Legal Business Name): JENNA L AIRD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2019
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 W FAIRVIEW AVE
HOMER AK
99603-7032
US

IV. Provider business mailing address

4300 BARTLETT ST
HOMER AK
99603-7000
US

V. Phone/Fax

Practice location:
  • Phone: 907-226-5600
  • Fax: 833-972-5924
Mailing address:
  • Phone: 907-226-5600
  • Fax: 833-972-5924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberPG193642
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number219753
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number67695
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: