Individual
ALICE RAVEN KENNEALLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
425 E DAHLIA AVE, PALMER, AK 99645-6463
(907) 376-2411
Mailing address
425 E DAHLIA AVE, PALMER, AK 99645-6463
(907) 376-2411
(907) 352-3301
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
233490
AK
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/03/2024
Last updated
04/30/2025
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