Provider Demographics
NPI:1043679764
Name:RAFFERTY, DEBRA
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:RAFFERTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:
Other - Last Name:RAFFERTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:49855 BISHOP DR
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-9439
Mailing Address - Country:US
Mailing Address - Phone:907-252-1938
Mailing Address - Fax:
Practice Address - Street 1:1365 E PARKS HIGHWAY
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8298
Practice Address - Country:US
Practice Address - Phone:907-357-6445
Practice Address - Fax:907-376-6402
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-23
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1638161Medicaid