Provider Demographics
NPI:1912433178
Name:PANIPTCHUK, KRISTIN
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:PANIPTCHUK
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 1:1ST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SHAKTOOLIK
Mailing Address - State:AK
Mailing Address - Zip Code:99771-0009
Mailing Address - Country:US
Mailing Address - Phone:907-955-3311
Mailing Address - Fax:907-955-2342
Practice Address - Street 1:1ST MAIN STREET
Practice Address - Street 2:
Practice Address - City:SHAKTOOLIK
Practice Address - State:AK
Practice Address - Zip Code:99771-0009
Practice Address - Country:US
Practice Address - Phone:907-955-3311
Practice Address - Fax:907-955-2342
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-10
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK172V00000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCHAOtherCHA