Provider Demographics
NPI:1972534816
Name:ALSTON, KAREN E (PAC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:E
Last Name:ALSTON
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 1:1276 KINOOLE ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4135
Mailing Address - Country:US
Mailing Address - Phone:808-784-3050
Mailing Address - Fax:808-784-3059
Practice Address - Street 1:1276 KINOOLE ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4135
Practice Address - Country:US
Practice Address - Phone:808-784-3050
Practice Address - Fax:808-784-3059
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT436363AS0400X
HIAMD-1070363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT97003OtherBCBS PROVIDER NUMBER
MT85100Medicare ID - Type Unspecified
MT97003OtherBCBS PROVIDER NUMBER