MEDICARE: ALEXANDER KRYVENIA PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PAC0967	ND
2	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1700160827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER KRYVENIA PA-C

Provider Business Mailing Address
First Line	:	1200 W NORTHERN LIGHTS BLVD
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-3652
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 W NORTHERN LIGHTS BLVD
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-3652
Country	:	US
Telephone Number	:	907-212-5165
Fax Number	:	907-212-0950

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2011
Last Update Date	:	03/08/2024

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