Individual
MRS. KELLY KATHLEEN ERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3245 HOSPITAL DR, JUNEAU, AK 99801-7809
(907) 463-4040
(907) 463-6663
Mailing address
641 W WILLOUGHBY AVE, STE 201, JUNEAU, AK 99801-1748
(908) 586-8100
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
666
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8EB370
MEDICARE ID -TYPE UNSPECI
AK
01
—
8EB371
MEDICARE ID -TYPE UNSPECI
AK
01
—
8EB372
MEDICARE ID-TYPE UNSPECIF
AK
01
—
8EB373
MEDICARE ID-TYPE UNSPECIF
AK
01
—
8ED920
MEDICARE ID-TYPE UNSPECIF
AK
Enumeration date
09/20/2006
Last updated
02/10/2020
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