Provider Demographics
NPI:1205368339
Name:ULERY, KIMBERLY SHAYD (CHA III)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SHAYD
Last Name:ULERY
Suffix:
Gender:F
Credentials:CHA III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:E STREET HOUSE 40
Mailing Address - Street 2:
Mailing Address - City:TYONEK
Mailing Address - State:AK
Mailing Address - Zip Code:99682-0034
Mailing Address - Country:US
Mailing Address - Phone:907-729-6753
Mailing Address - Fax:907-583-2155
Practice Address - Street 1:101 INDIAN CREEK ROAD
Practice Address - Street 2:BOX 82068
Practice Address - City:TYONEK
Practice Address - State:AK
Practice Address - Zip Code:99682-0068
Practice Address - Country:US
Practice Address - Phone:907-729-6752
Practice Address - Fax:907-583-2155
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK16-1413-III172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker