Organization
KENAI FAMILY PRACTICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TERRI L ELLIOTT D.O. (OWNER)
(907) 335-0034
Entity
Organization
Contact information
Practice address
135 BIDARKA ST, SUITE 101, KENAI, AK 99611-7741
(907) 335-0034
(907) 335-0064
Mailing address
135 BIDARKA ST, SUITE 101, KENAI, AK 99611-7741
(907) 335-0034
(907) 335-0064
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4040
AK
363A00000X
Physician Assistant
725
AK
363L00000X
Nurse Practitioner
175
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
K152261
MEDICARE GROUP LEGACY
AK
Enumeration date
09/28/2007
Last updated
06/09/2008
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