Provider Demographics
NPI:1114154549
Name:KNUTSON, KATHLEEN C (ANP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:C
Last Name:KNUTSON
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 K ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-3331
Mailing Address - Country:US
Mailing Address - Phone:907-272-2571
Mailing Address - Fax:907-272-6751
Practice Address - Street 1:718 K ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-3331
Practice Address - Country:US
Practice Address - Phone:907-272-2571
Practice Address - Fax:907-272-6751
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1081363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner