Provider Demographics
NPI:1518516095
Name:HUSTON, KELSEY JEANNE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KELSEY
Middle Name:JEANNE
Last Name:HUSTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3851 PIPER ST STE U462
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-6905
Mailing Address - Country:US
Mailing Address - Phone:907-562-6262
Mailing Address - Fax:907-562-6267
Practice Address - Street 1:3851 PIPER ST STE U462
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-6905
Practice Address - Country:US
Practice Address - Phone:907-562-6262
Practice Address - Fax:907-562-6267
Is Sole Proprietor?:No
Enumeration Date:2019-09-08
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK171479363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1718325Medicaid