Provider Demographics
NPI:1356553655
Name:KORN, PAULA (ANP)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:KORN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 LAKE OTIS PKWY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5207
Mailing Address - Country:US
Mailing Address - Phone:907-277-2597
Mailing Address - Fax:907-277-2598
Practice Address - Street 1:3650 LAKE OTIS PKWY
Practice Address - Street 2:SUITE 140
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5207
Practice Address - Country:US
Practice Address - Phone:907-277-2597
Practice Address - Fax:907-277-2598
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK09367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNM0199Medicaid