Provider Demographics
NPI:1659670578
Name:PLESS, KELLY BARBARA (LE)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:BARBARA
Last Name:PLESS
Suffix:
Gender:F
Credentials:LE
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:BARBARA
Other - Last Name:WHITWORTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LE
Mailing Address - Street 1:3851 PIPER ST
Mailing Address - Street 2:SUITE U464
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4684
Mailing Address - Country:US
Mailing Address - Phone:907-770-6700
Mailing Address - Fax:907-770-6707
Practice Address - Street 1:5201 E NORTHERN LIGHTS BLVD
Practice Address - Street 2:UNIT 8N
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4776
Practice Address - Country:US
Practice Address - Phone:907-317-9328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKHADC15040174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist