Healthcare Provider Details

I. General information

NPI: 1285316612
Provider Name (Legal Business Name): KAYLA BEKKERUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2023
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 FIFTH AVE
KETCHIKAN AK
99901-5773
US

IV. Provider business mailing address

3051 VINTAGE BVLD
JUNEAU AK
99801
US

V. Phone/Fax

Practice location:
  • Phone: 907-225-4135
  • Fax:
Mailing address:
  • Phone: 907-463-0160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: