Provider Demographics
NPI:1730386293
Name:SMALLEY, KRISTINA M (PA)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:M
Last Name:SMALLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2121 ABBOTT RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-4450
Mailing Address - Country:US
Mailing Address - Phone:907-802-1497
Mailing Address - Fax:907-339-8786
Practice Address - Street 1:2121 ABBOTT RD STE 101
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-4450
Practice Address - Country:US
Practice Address - Phone:907-802-1497
Practice Address - Fax:907-339-8786
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA002207363A00000X
AK225667363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant