Provider Demographics
NPI:1710390620
Name:KOHLER-KRAVA, ELLEN K (ARNP)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:K
Last Name:KOHLER-KRAVA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:VICKREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3900 AMBASSADOR DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5922
Mailing Address - Country:US
Mailing Address - Phone:907-729-1500
Mailing Address - Fax:
Practice Address - Street 1:4000 AMBASSADOR DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5909
Practice Address - Country:US
Practice Address - Phone:907-729-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK110800363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner