Individual
MS. KELLY DENISE GRIFFIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN FNP-C
Contact information
Practice address
8505 OLD DIARY RD, JUNEU, AK 99801
(907) 790-4111
(907) 790-3111
Mailing address
8505 OLD DIARY RD, JUNEU, AK 99801
(907) 790-4111
(907) 790-3111
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN104391
AZ
363LF0000X
Family Nurse Practitioner
Primary
202259
AK
363LF0000X
Family Nurse Practitioner
AP7749
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016759
—
AZ
01
—
03-1815
MEDICARE
—
05
—
1737735
—
AK
05
—
912044
—
AZ
01
—
ZFQ31815
MEDICARE
—
Enumeration date
02/19/2015
Last updated
01/24/2024
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