Healthcare Provider Details

I. General information

NPI: 1275277238
Provider Name (Legal Business Name): KIMBERLY JO CRANDALL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 N HEMMER RD STE 208
PALMER AK
99645-9673
US

IV. Provider business mailing address

1901 N HEMMER RD STE 208
PALMER AK
99645-9673
US

V. Phone/Fax

Practice location:
  • Phone: 907-203-4677
  • Fax: 800-516-0397
Mailing address:
  • Phone: 907-203-4677
  • Fax: 800-892-4144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number198965
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberNURR26951
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: