Individual
KIRA POLK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
460 RIDGECREST DRIVE, SUITE 215, BETHEL, AK 99559
(907) 543-2762
(907) 543-3152
Mailing address
P.O. BOX 528, ATTN: BH DD SERVICES, BETHEL, AK 99559
(907) 543-2762
(907) 543-3152
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1002447
—
AK
05
—
1004541
—
AK
Enumeration date
08/28/2017
Last updated
08/28/2017
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