Provider Demographics
NPI:1003264052
Name:TURNER, KIMBERLEY (PA-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:
Last Name:TURNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 BARBARA ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99517-1859
Mailing Address - Country:US
Mailing Address - Phone:907-240-2227
Mailing Address - Fax:
Practice Address - Street 1:1400 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-2857
Practice Address - Country:US
Practice Address - Phone:907-269-4234
Practice Address - Fax:907-269-4235
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK127143363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1683823Medicaid