Provider Demographics
NPI:1801138565
Name:OYOUMICK, KATHLEEN EDNA
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:EDNA
Last Name:OYOUMICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 N. HAPPY VALLEY RD.
Mailing Address - Street 2:
Mailing Address - City:UNALAKLEET
Mailing Address - State:AK
Mailing Address - Zip Code:99684-0189
Mailing Address - Country:US
Mailing Address - Phone:907-924-3535
Mailing Address - Fax:907-924-3692
Practice Address - Street 1:189 N. HAPPY VALLEY RD.
Practice Address - Street 2:
Practice Address - City:UNALAKLEET
Practice Address - State:AK
Practice Address - Zip Code:99684-0189
Practice Address - Country:US
Practice Address - Phone:907-924-3535
Practice Address - Fax:907-924-3692
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK13-1233-III172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK13-1233-IIIOtherCHA III