Provider Demographics
NPI:1760925408
Name:KAUFMAN, JEANA CAMPBELL
Entity Type:Individual
Prefix:
First Name:JEANA
Middle Name:CAMPBELL
Last Name:KAUFMAN
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 1:12541 LANDMARK ST
Mailing Address - Street 2:APT 2
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-4158
Mailing Address - Country:US
Mailing Address - Phone:907-250-9260
Mailing Address - Fax:
Practice Address - Street 1:2804 W NORTHERN LIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99517-9951
Practice Address - Country:US
Practice Address - Phone:907-250-9260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-29
Last Update Date:2022-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK143609225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation