Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 8020 | AK |
N | 207Q00000X | Family Doctor | 5315046213 | MI |
N | 207Q00000X | Family Doctor | 8020 | AK |
NPI | 1093026718 |
---|---|
Provider Name | Kathleen Carey |
First Address | Fairbanks, AK 99701-4948 |
Second Address | Fairbanks, AK 99701-4948 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2010 |
Last Update Date | 18/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1618463 | (05) | AK |