Provider Demographics
NPI:1164799409
Name:THIEMEYER, KATHY S (CHA IV)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:S
Last Name:THIEMEYER
Suffix:
Gender:F
Credentials:CHA IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 70
Mailing Address - Street 2:
Mailing Address - City:KOYUK
Mailing Address - State:AK
Mailing Address - Zip Code:99753-0070
Mailing Address - Country:US
Mailing Address - Phone:907-963-3311
Mailing Address - Fax:907-963-3610
Practice Address - Street 1:EAST 2ND AVENUE
Practice Address - Street 2:
Practice Address - City:KOYUK
Practice Address - State:AK
Practice Address - Zip Code:99753-0070
Practice Address - Country:US
Practice Address - Phone:907-963-3311
Practice Address - Fax:907-963-3610
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK98-137-IV172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK98-137-IVOtherCHA IV