Individual
KANEEKA AUSTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3100 S CUSHMAN ST, FAIRBANKS, AK 99701-7516
(907) 452-1648
Mailing address
3100 S CUSHMAN ST, FAIRBANKS, AK 99701-7516
(907) 452-1648
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
A9545109
—
AK
Enumeration date
04/26/2022
Last updated
04/26/2022
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