Healthcare Provider Details

I. General information

NPI: 1841245388
Provider Name (Legal Business Name): KIMBERLY LYNN BAKKES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY LYNN MERRIS MD

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 KATLIAN ST STE E
SITKA AK
99835-7359
US

IV. Provider business mailing address

700 KATLIAN ST STE E
SITKA AK
99835-7359
US

V. Phone/Fax

Practice location:
  • Phone: 907-747-5861
  • Fax:
Mailing address:
  • Phone: 907-747-5861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5390
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number015656
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: