Provider Demographics
NPI:1205567492
Name:MCGOVERN, KIANA CLAREY
Entity type:Individual
Prefix:
First Name:KIANA
Middle Name:CLAREY
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIANA
Other - Middle Name:NANETTE
Other - Last Name:CLAREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16941 N EAGLE RIVER LOOP RD STE 3
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7824
Mailing Address - Country:US
Mailing Address - Phone:907-206-4421
Mailing Address - Fax:907-726-5366
Practice Address - Street 1:16941 N EAGLE RIVER LOOP RD STE 3
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7824
Practice Address - Country:US
Practice Address - Phone:907-206-4421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKRBT-22-22160106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician