Provider Demographics
NPI:1902150139
Name:ANSON, KERRY A (PA-C, ATC)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:A
Last Name:ANSON
Suffix:
Gender:F
Credentials:PA-C, ATC
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:A
Other - Last Name:KUCKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3066 E MERIDIAN PARK LOOP
Mailing Address - Street 2:STE 3
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7254
Mailing Address - Country:US
Mailing Address - Phone:907-357-9590
Mailing Address - Fax:907-357-9593
Practice Address - Street 1:17025 SNOWMOBILE LN
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7044
Practice Address - Country:US
Practice Address - Phone:907-694-9553
Practice Address - Fax:907-694-9585
Is Sole Proprietor?:No
Enumeration Date:2012-11-09
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1073363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical