Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 376 | AK |
Y | 103TC0700X | Clinical Psychologist | 376 | AK |
NPI | 1003304346 |
---|---|
Provider Name | James Kyle Timmons |
First Address | Anchorage, AK 99503-1728 |
Second Address | Anchorage, AK 99503-1728 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2018 |
Last Update Date | 23/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
376 | STATE OF ALASKA (01) | AK |