Provider Demographics
NPI:1790974079
Name:POWERS, KYNA (FNP)
Entity Type:Individual
Prefix:
First Name:KYNA
Middle Name:
Last Name:POWERS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KYNA
Other - Middle Name:
Other - Last Name:KYNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:300 E. DIMOND BLVD.
Mailing Address - Street 2:SUITE 12
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515
Mailing Address - Country:US
Mailing Address - Phone:907-341-7757
Mailing Address - Fax:907-341-7760
Practice Address - Street 1:300 E. DIMOND BLVD.
Practice Address - Street 2:SUITE 12
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515
Practice Address - Country:US
Practice Address - Phone:907-341-7757
Practice Address - Fax:907-341-7760
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK412364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1683477Medicaid