Provider Demographics
NPI:1649384744
Name:FELKER, KATHIE LORRAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHIE
Middle Name:LORRAINE
Last Name:FELKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATHIE
Other - Middle Name:LORRAINE
Other - Last Name:STIRLING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, INC
Mailing Address - Street 1:515 7TH AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4933
Mailing Address - Country:US
Mailing Address - Phone:907-456-3545
Mailing Address - Fax:907-456-3579
Practice Address - Street 1:515 7TH AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4933
Practice Address - Country:US
Practice Address - Phone:907-456-3545
Practice Address - Fax:907-456-3579
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA2262174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD98841Medicaid
AK200961349OtherFED TAX ID NUMBER
AKA89724Medicare UPIN