Provider Demographics
NPI:1184946154
Name:KUNKEL, ALI EVELYN (PA-C)
Entity type:Individual
Prefix:MISS
First Name:ALI
Middle Name:EVELYN
Last Name:KUNKEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 BARRANCA AVE APT B
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93109-4203
Mailing Address - Country:US
Mailing Address - Phone:559-360-0797
Mailing Address - Fax:
Practice Address - Street 1:120 BARRANCA AVE APT B
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93109-4203
Practice Address - Country:US
Practice Address - Phone:559-360-0797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20840363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant