Provider Demographics
NPI:1306268628
Name:TUMA, KATI JO (MMS, PA-C)
Entity type:Individual
Prefix:
First Name:KATI
Middle Name:JO
Last Name:TUMA
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:J
Other - Last Name:TUMA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MMS, PA-C
Mailing Address - Street 1:1314 SHUROS DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-6740
Mailing Address - Country:US
Mailing Address - Phone:307-267-6150
Mailing Address - Fax:866-598-2420
Practice Address - Street 1:1275 SADLER WAY STE 105
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-3175
Practice Address - Country:US
Practice Address - Phone:307-267-6150
Practice Address - Fax:866-598-2420
Is Sole Proprietor?:No
Enumeration Date:2014-01-07
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPA586363AM0700X
AK135795363AM0700X
WYTL586363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical