Provider Demographics
NPI:1326264219
Name:WELSER, KURT WALTER (PA-C)
Entity Type:Individual
Prefix:MR
First Name:KURT
Middle Name:WALTER
Last Name:WELSER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:SUZANNE
Other - Middle Name:IRENE
Other - Last Name:WELSER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:120 FREEMAN DRIVE
Mailing Address - Street 2:P.O. BOX 19290
Mailing Address - City:THORNE BAY
Mailing Address - State:AK
Mailing Address - Zip Code:99919
Mailing Address - Country:US
Mailing Address - Phone:907-828-8848
Mailing Address - Fax:907-828-3409
Practice Address - Street 1:120 FREEMAN DR.
Practice Address - Street 2:SEARHC CLINIC
Practice Address - City:THORNE BAY
Practice Address - State:AK
Practice Address - Zip Code:99919
Practice Address - Country:US
Practice Address - Phone:907-828-8848
Practice Address - Fax:907-828-3409
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK372363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKS22923Medicare UPIN
AK8EC594Medicare ID - Type Unspecified
AK8EC592Medicare PIN
AK8EC593Medicare PIN
AK8EZ11BMedicare PIN
AK8EC591Medicare PIN