Provider Demographics
NPI:1922158864
Name:JAKIEMIEC, KRISTINE M (PAC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:M
Last Name:JAKIEMIEC
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 S DENALI ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-6439
Mailing Address - Country:US
Mailing Address - Phone:907-745-7944
Mailing Address - Fax:
Practice Address - Street 1:561 S DENALI ST
Practice Address - Street 2:SUITE E
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6439
Practice Address - Country:US
Practice Address - Phone:907-745-7944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAK1838363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant