Provider Demographics
NPI:1285938050
Name:LORAN, KIM I (PA-C)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:I
Last Name:LORAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-7032
Mailing Address - Country:US
Mailing Address - Phone:907-435-0555
Mailing Address - Fax:844-274-6970
Practice Address - Street 1:205 W FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7032
Practice Address - Country:US
Practice Address - Phone:907-435-0555
Practice Address - Fax:844-274-6970
Is Sole Proprietor?:No
Enumeration Date:2011-01-07
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2107363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1571285Medicaid