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General NPI Number Information
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NPI Number | 1154951010
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Entity Type | Individual
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Provider Name | KRISTAL ANN KINSEY MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/20/2020
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Last Update Date | 11/02/2022
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Provider Practice Location Address
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Address Line | 100 CUSHMAN ST STE 309
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City | FAIRBANKS
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State | AK
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Zip | 99701-4673
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Country | US
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Telephone | 907-318-5686
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Fax | 907-917-4166
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Provider Business Mailing Address
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Address Line | PO BOX 35360
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City | FORT WAINWRIGHT
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State | AK
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Zip | 99703-0360
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Country | US
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Telephone | 731-845-9786
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 168649
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 168649
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License Number State | AK
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