Basic Information
| Provider Information | |||||||||
| NPI: | 1790974079 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POWERS | ||||||||
| FirstName: | KYNA | ||||||||
| MiddleName: | |||||||||
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| Credential: | FNP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | KYNA | ||||||||
| OtherFirstName: | KYNA | ||||||||
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| OtherCredential: | NP | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 300 E. DIMOND BLVD. | ||||||||
| Address2: | SUITE 12 | ||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073417757 | ||||||||
| FaxNumber: | 9073417760 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 E. DIMOND BLVD. | ||||||||
| Address2: | SUITE 12 | ||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073417757 | ||||||||
| FaxNumber: | 9073417760 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2007 | ||||||||
| LastUpdateDate: | 01/02/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SF0001X | 412 | AK | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Family Health |
ID Information
| ID | Type | State | Issuer | Description | 1683477 | 05 | AK | MEDICAID |