Healthcare Provider Details

I. General information

NPI: 1467325415
Provider Name (Legal Business Name): KRISTEN PRESTEGARD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2025
Last Update Date: 07/12/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3719 E MERIDIAN LOOP STE E
WASILLA AK
99654-7273
US

IV. Provider business mailing address

447 E 76TH AVE APT 2
ANCHORAGE AK
99518-2883
US

V. Phone/Fax

Practice location:
  • Phone: 907-600-0030
  • Fax: 907-206-7153
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: