Provider Demographics
NPI:1558747873
Name:FLENSBURG, KEILYN MARGARET (CHA IV)
Entity type:Individual
Prefix:MISS
First Name:KEILYN
Middle Name:MARGARET
Last Name:FLENSBURG
Suffix:
Gender:F
Credentials:CHA IV
Other - Prefix:
Other - First Name:KEILYN
Other - Middle Name:MARGARET
Other - Last Name:CARLOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:DILLINGHAM
Mailing Address - State:AK
Mailing Address - Zip Code:99576-0130
Mailing Address - Country:US
Mailing Address - Phone:907-842-9491
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 130
Practice Address - Street 2:
Practice Address - City:DILLINGHAM
Practice Address - State:AK
Practice Address - Zip Code:99576-0130
Practice Address - Country:US
Practice Address - Phone:907-842-9491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK14-1305-IV172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1635441Medicaid