Provider Demographics
NPI:1528396793
Name:THYNES-LEIGHTON, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:THYNES-LEIGHTON
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 1:201 DEERMOUNT ST
Mailing Address - Street 2:
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-6649
Mailing Address - Country:US
Mailing Address - Phone:907-225-7825
Mailing Address - Fax:907-225-1541
Practice Address - Street 1:201 DEERMOUNT ST
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-6649
Practice Address - Country:US
Practice Address - Phone:907-225-7825
Practice Address - Fax:907-225-1541
Is Sole Proprietor?:No
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator