Provider Demographics
NPI:1407279565
Name:ADIELE, KIM MYOMI (MSW)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:MYOMI
Last Name:ADIELE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:MYOMI
Other - Last Name:PARRAWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:PO BOX 528
Mailing Address - Street 2:ATTN: BEHAVIORAL HEALTH
Mailing Address - City:BETHEL
Mailing Address - State:AK
Mailing Address - Zip Code:99559-0528
Mailing Address - Country:US
Mailing Address - Phone:907-543-6100
Mailing Address - Fax:907-543-6159
Practice Address - Street 1:829 CHIEF EDDIE HOFFMAN HWY
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:AK
Practice Address - Zip Code:99559-0528
Practice Address - Country:US
Practice Address - Phone:907-543-6100
Practice Address - Fax:907-543-6159
Is Sole Proprietor?:No
Enumeration Date:2014-01-27
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1020986Medicaid