Provider Demographics
NPI:1154951010
Name:KINSEY, KRISTAL ANN (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:KRISTAL
Middle Name:ANN
Last Name:KINSEY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:KRISTAL
Other - Middle Name:ANN
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:PO BOX 35360
Mailing Address - Street 2:
Mailing Address - City:FORT WAINWRIGHT
Mailing Address - State:AK
Mailing Address - Zip Code:99703-0360
Mailing Address - Country:US
Mailing Address - Phone:731-845-9786
Mailing Address - Fax:
Practice Address - Street 1:100 CUSHMAN ST STE 309
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4673
Practice Address - Country:US
Practice Address - Phone:907-318-5686
Practice Address - Fax:907-917-4166
Is Sole Proprietor?:No
Enumeration Date:2020-01-20
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK168649104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker