Provider Demographics
NPI:1477692838
Name:DOSTAL, KIMBERLY PARK (CNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:PARK
Last Name:DOSTAL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 HOSPITAL DR
Mailing Address - Street 2:# 102
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-7809
Mailing Address - Country:US
Mailing Address - Phone:907-586-3068
Mailing Address - Fax:907-586-3078
Practice Address - Street 1:3225 HOSPITAL DR
Practice Address - Street 2:# 102
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801
Practice Address - Country:US
Practice Address - Phone:907-586-3068
Practice Address - Fax:907-586-3078
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK16309163W00000X
AK357363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKAP0350Medicaid
AKAP0350Medicaid
S03314Medicare UPIN