Provider Demographics
NPI:1891741526
Name:DORIUS, KERRY (ANP)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:DORIUS
Suffix:
Gender:F
Credentials:ANP
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 1130
Mailing Address - Street 2:
Mailing Address - City:GIRDWOOD
Mailing Address - State:AK
Mailing Address - Zip Code:99587-1130
Mailing Address - Country:US
Mailing Address - Phone:907-783-1355
Mailing Address - Fax:907-783-1357
Practice Address - Street 1:131 LINDBLAD AVE.
Practice Address - Street 2:
Practice Address - City:GIRDWOOD
Practice Address - State:AK
Practice Address - Zip Code:99587-5623
Practice Address - Country:US
Practice Address - Phone:907-783-1355
Practice Address - Fax:907-783-1357
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK362363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALNPO3624Medicaid
ALNPO3624Medicaid
AK151119Medicare ID - Type Unspecified