Provider Demographics
NPI:1477523884
Name:KUBLY, KEVIN L (PA-C)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:L
Last Name:KUBLY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 FAIRBANKS ST STE A
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-4165
Mailing Address - Country:US
Mailing Address - Phone:907-561-3488
Mailing Address - Fax:
Practice Address - Street 1:3300 FAIRBANKS ST STE A
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-4165
Practice Address - Country:US
Practice Address - Phone:907-561-3488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
AKPADA9782083B0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant