Provider Demographics
NPI:1477238319
Name:PAUL-FRANK, KASSIUS KAYLYNN
Entity Type:Individual
Prefix:
First Name:KASSIUS
Middle Name:KAYLYNN
Last Name:PAUL-FRANK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3568 GERAGHTY AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-4701
Mailing Address - Country:US
Mailing Address - Phone:907-206-7402
Mailing Address - Fax:907-374-7008
Practice Address - Street 1:3568 GERAGHTY AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-4701
Practice Address - Country:US
Practice Address - Phone:907-206-7402
Practice Address - Fax:907-374-7008
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician