Provider Demographics
NPI:1194997429
Name:DENALI FAMILY HEALTHCARE, LLC
Entity type:Organization
Organization Name:DENALI FAMILY HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:EILENE
Authorized Official - Last Name:SEXSON
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:907-277-4584
Mailing Address - Street 1:2841 DEBARR RD STE 22
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2945
Mailing Address - Country:US
Mailing Address - Phone:907-277-4584
Mailing Address - Fax:907-277-3342
Practice Address - Street 1:2841 DEBARR RD STE 22
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2945
Practice Address - Country:US
Practice Address - Phone:907-277-4584
Practice Address - Fax:907-277-3342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK913309261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP3602Medicaid
AKNP3602Medicaid
AKK160046Medicare PIN