Provider Demographics
NPI:1487259677
Name:NIELSEN, KAILI (DPT)
Entity type:Individual
Prefix:
First Name:KAILI
Middle Name:
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KAILI
Other - Middle Name:
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8390 AIRPORT BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-6927
Mailing Address - Country:US
Mailing Address - Phone:907-789-4165
Mailing Address - Fax:
Practice Address - Street 1:8390 AIRPORT BLVD STE 203
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-6927
Practice Address - Country:US
Practice Address - Phone:907-789-4165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK168116208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation