Healthcare Provider Details

I. General information

NPI: 1912433178
Provider Name (Legal Business Name): KRISTIN PANIPTCHUK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2017
Last Update Date: 10/21/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1ST MAIN STREET
SHAKTOOLIK AK
99771-0009
US

IV. Provider business mailing address

1ST MAIN STREET
SHAKTOOLIK AK
99771-0009
US

V. Phone/Fax

Practice location:
  • Phone: 907-955-3311
  • Fax: 907-955-2342
Mailing address:
  • Phone: 907-955-3311
  • Fax: 907-955-2342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: