Provider Demographics
NPI:1063181659
Name:HAYDEN, KARA (LMT)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:HAYDEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5205 CARIBOU AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2509
Mailing Address - Country:US
Mailing Address - Phone:907-444-8222
Mailing Address - Fax:907-929-7685
Practice Address - Street 1:4000 W DIMOND BLVD UNIT 4
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-1474
Practice Address - Country:US
Practice Address - Phone:907-243-0660
Practice Address - Fax:907-248-5481
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK175964225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist