Provider Demographics
NPI:1275667800
Name:GERRISH, KIRSTEN A (CDM)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:A
Last Name:GERRISH
Suffix:
Gender:F
Credentials:CDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 S TRUNK RD
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-5940
Mailing Address - Country:US
Mailing Address - Phone:907-746-6644
Mailing Address - Fax:317-667-1982
Practice Address - Street 1:2323 S TRUNK RD
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-5940
Practice Address - Country:US
Practice Address - Phone:907-746-6644
Practice Address - Fax:317-667-1982
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA33176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1022143Medicaid