Individual
STACEY PAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
230 E MARYDALE AVE, SOLDOTNA, AK 99669-7648
(907) 262-3119
(907) 262-9290
Mailing address
230 E MARYDALE AVE, SOLDOTNA, AK 99669-7648
(907) 262-3119
(907) 262-9290
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA-3281
CO
363AM0700X
Medical Physician Assistant
Primary
127937
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1679563
—
AK
Enumeration date
08/18/2011
Last updated
03/26/2021
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