Provider Demographics
NPI:1497819841
Name:ERHART, KRISTINA MARIE (PAC)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MARIE
Last Name:ERHART
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 W BENSON BLVD
Mailing Address - Street 2:SUITE 315
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3679
Mailing Address - Country:US
Mailing Address - Phone:907-929-4009
Mailing Address - Fax:907-929-4902
Practice Address - Street 1:1400 W BENSON BLVD
Practice Address - Street 2:SUITE 315
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3679
Practice Address - Country:US
Practice Address - Phone:907-929-4009
Practice Address - Fax:907-929-4902
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKPA443363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK043650384OtherNORTHWEST NPI SERVICES
AK043650384OtherPREMARA
AK043650384OtherBCBS
AK043650384OtherOTHER PAR & NONPAR PAYERS
AKMD22813Medicaid
AK043650384OtherPREMARA
AK043650384OtherOTHER PAR & NONPAR PAYERS