Provider Demographics
NPI:1255693578
Name:EASTMAN, KRISTIN L (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:L
Last Name:EASTMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1243
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-1243
Mailing Address - Country:US
Mailing Address - Phone:907-398-3376
Mailing Address - Fax:907-420-0435
Practice Address - Street 1:130 E REDOUBT AVE
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-8012
Practice Address - Country:US
Practice Address - Phone:907-398-3376
Practice Address - Fax:907-420-0435
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AK109775207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1653922Medicaid