Provider Demographics
NPI:1730677410
Name:PETERS, KRISTY ANN (CT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:ANN
Last Name:PETERS
Suffix:
Gender:F
Credentials:CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:DILLINGHAM
Mailing Address - State:AK
Mailing Address - Zip Code:99576-0130
Mailing Address - Country:US
Mailing Address - Phone:907-842-5266
Mailing Address - Fax:907-842-5195
Practice Address - Street 1:1600 KANAKANAK RD
Practice Address - Street 2:SUITE 130
Practice Address - City:DILLINGHAM
Practice Address - State:AK
Practice Address - Zip Code:99576-0130
Practice Address - Country:US
Practice Address - Phone:907-842-5266
Practice Address - Fax:907-842-5195
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)