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General NPI Number Information
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NPI Number | 1245152149
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Entity Type | Organization
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Legal Business Name | KETCHIKAN FUNCTIONAL MEDICINE
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Dates
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Enumeration Date | 07/29/2026
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Last Update Date | 07/29/2026
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Provider Practice Location Address
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Address Line | 3159 TONGASS AVE
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City | KETCHIKAN
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State | AK
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Zip | 99901-5745
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Country | US
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Telephone | 907-225-4001
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Fax | 907-225-4006
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Provider Business Mailing Address
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Address Line | 3159 TONGASS AVE
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City | KETCHIKAN
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State | AK
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Zip | 99901-5745
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Country | US
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Telephone | 907-225-4001
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Fax | 907-225-4006
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Authorized Official
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Title or Position | OWNER
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Name | MARY BETH PATTERSON
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Credential | APRN, FNP-C
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Telephone | 520-981-3725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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