Provider Demographics
NPI:1841245388
Name:BAKKES, KIMBERLY LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:LYNN
Last Name:BAKKES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:LYNN
Other - Last Name:MERRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:700 KATLIAN ST STE E
Mailing Address - Street 2:
Mailing Address - City:SITKA
Mailing Address - State:AK
Mailing Address - Zip Code:99835-7359
Mailing Address - Country:US
Mailing Address - Phone:907-747-5861
Mailing Address - Fax:
Practice Address - Street 1:700 KATLIAN ST STE E
Practice Address - Street 2:
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835-7359
Practice Address - Country:US
Practice Address - Phone:907-747-5861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5390207Q00000X
ME015656207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD29523Medicaid
MEH43997 (31142)Medicare UPIN
AKH43997 (00900)Medicare UPIN
AKMD29523Medicaid
AK161040Medicare PIN