Provider Demographics
NPI:1265179360
Name:PAUK, KAITLYN
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:PAUK
Suffix:
Gender:F
Credentials:
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 70
Mailing Address - Street 2:
Mailing Address - City:TOGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99678-0070
Mailing Address - Country:US
Mailing Address - Phone:907-493-5511
Mailing Address - Fax:
Practice Address - Street 1:70 MAIN STREET
Practice Address - Street 2:
Practice Address - City:TOGIAK
Practice Address - State:AK
Practice Address - Zip Code:99678
Practice Address - Country:US
Practice Address - Phone:907-493-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker