Provider Demographics
NPI:1003304346
Name:TIMMONS, JAMES KYLE (PHD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:KYLE
Last Name:TIMMONS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 POTLATCH CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-1728
Mailing Address - Country:US
Mailing Address - Phone:907-947-1862
Mailing Address - Fax:
Practice Address - Street 1:1020 POTLATCH CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-1728
Practice Address - Country:US
Practice Address - Phone:907-947-1862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK376103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK376OtherSTATE OF ALASKA