KIRA POLK (NPI# 1710404074) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710404074 |
| Entity Type | Individual |
| Full Name | KIRA POLK |
| Practice Address |
460 Ridgecrest Drive Suite 215 Bethel AK 99559 |
| Mailing Address |
P.o. Box 528 Attn: Bh Dd Services Bethel AK 99559 |
| Practice Telephone | 9075432762 |
| Practice Fax Number | 9075433152 |
| Mailing Telephone | 9075432762 |
| Mailing Fax Number | 9075433152 |
| Enumeration Date | 2017-08-28 |
| Last Update Date | 2017-08-28 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 373H00000X | Day Training/Habilitation Specialist | Nursing Service Related Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AK | 1004541 | 05 | |
| AK | 1002447 | 05 |
| Street Address |
460 RIDGECREST DRIVE SUITE 215 |
| City | BETHEL |
| State | AK |
| Zip Code | 99559 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508052820 | Serena Rose Solesbee | Case Manager/Care Coordinator | 460 Ridgecrest Drive, Suite 215, Bethel, AK 99559-0528 | 2007-09-20 |
| 1225565831 | Deonna Graham | Day Training/Habilitation Specialist | 460 Ridgecrest Drive, Suite 214, Bethel, AK 99559-0528 | 2017-05-12 |
| 1619423571 | Rochelle Andrews | Case Manager/Care Coordinator | 460 Ridgecrest Drive, Suite 209, Bethel, AK 99559-0528 | 2016-08-31 |
| 1750737292 | Stacy Taylor | Case Manager/Care Coordinator | 460 Ridgecrest Drive, Suite 209, Bethel, AK 99559-0528 | 2016-05-13 |
| 1164896775 | Alexandra Active | Case Manager/Care Coordinator | 460 Ridgecrest Drive, Suite 215, Bethel, AK 99559-0528 | 2015-11-19 |
| 1275909012 | Jaris Michaels | Case Manager/Care Coordinator | 460 Ridgecrest Drive, Suite 215, Bethel, AK 99559 | 2015-08-17 |
| 1013383850 | Ivy Katherine Riley | Case Manager/Care Coordinator | 460 Ridgecrest Drive, Suite 215, Bethel, AK 99559 | 2015-08-17 |
| 1962880237 | Colleen Chase | Case Manager/Care Coordinator | 460 Ridgecrest Drive, Suite 215, Bethel, AK 99559 | 2015-05-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194337519 | Michael P Nicolai | Case Manager/Care Coordinator | 829 Chief Eddie Hoffman Hey, Bethel, AK 99559 | 2020-08-18 |
| 1003438508 | Enc Physical Therapy LLC | Physical Therapist | 223 Blackberry Street, Unit A, Bethel, AK 99559 | 2020-05-07 |
| 1780229609 | Laline Knox | Massage Therapist | 107 Alex Hatley Ste 1, Bethel, AK 99559 | 2019-11-14 |
| 1659920502 | Ana Celina Sebastian | Counselor | 1380 Calista Dr, Bethel, AK 99559 | 2019-09-04 |
| 1639730484 | Jerri Linda Moran-gentle | Massage Therapist | 430 A 7th Ave, Bethel, AK 99559 | 2019-06-24 |
| 1528625381 | Jennifer Peeks | Social Worker | 631 4th Ave. & Main St., Bethel, AK 99559 | 2019-05-28 |
| 1710451190 | Mary Theresa Thibeault | Registered Nurse | Bethel Public Health Center, 1490 Eddie Hoffman Highway, Bethel, AK 99559 | 2019-01-18 |
| 1659846210 | Freda Lizann Jimmie | Counselor | 829 Eddie Hoffman Highway, Bethel, AK 99559 | 2018-10-10 |
| 1073093977 | Romeo Mullai | Counselor | 1630 Calista Drive, Bethel, AK 99559 | 2018-08-20 |
| 1235623794 | Brian Justin Moses | Day Training/Habilitation Specialist | 841 Chief Eddie Hoffman Highway, Bethel, AK 99559 | 2018-06-19 |
| Find all providers in zip 99559 | ||||
| Taxonomy Code | 373H00000X |
| Grouping | Nursing Service Related Providers |
| Classification | Day Training/Habilitation Specialist |
| Individuals experienced or trained in working with developmentally disabled individuals who need assistance in acquiring and maintaining life skills that enable them to cope more effectively with the demands of independent living. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235623794 | Brian Justin Moses | Day Training/Habilitation Specialist | 841 Chief Eddie Hoffman Highway, Bethel, AK 99559 | 2018-06-19 |
| 1528598323 | Helen Alice Charlie | Day Training/Habilitation Specialist | 839 Cheif Eddy Hoffman Highway, Bethel, AK 99559 | 2017-06-14 |
| 1790179281 | Anna M Tinker | Day Training/Habilitation Specialist | 841 Chief Eddie Hoffman Hwy, Bethel, AK 99559-0528 | 2015-03-24 |
| 1487062295 | Matthew Raymond Lautersack | Day Training/Habilitation Specialist | 839 Chief Eddie Hoffman Hwy., Bethel, AK 99559-0528 | 2014-07-24 |
| 1679983514 | Tanya Chavez | Day Training/Habilitation Specialist | 839 Cheif Hoffmen Sub, Bethel, AK 99559-0258 | 2014-04-30 |
| 1700055233 | Peggy C Peter | Day Training/Habilitation Specialist | 700 Chielf Eddie Hoffman Highway, Bethel, AK 99559 | 2008-02-28 |
| 1114132339 | Emily Ramona Atti | Day Training/Habilitation Specialist | 839 Chief Eddie Hoffman Highway, Bethel, AK 99559-0528 | 2007-05-11 |
| 1174155659 | Briann L Jacob | Day Training/Habilitation Specialist | 841 State Hwy, Bethel, AK 99559 | 2020-02-12 |
| 1598315632 | Paige Marie Atcherian | Day Training/Habilitation Specialist | 839 Chief Eddie Hoffman Hwy, Bethel, AK 99559 | 2019-09-19 |
| 1114579729 | Kay Renee Vienup | Day Training/Habilitation Specialist | 839 Chief Eddie Hoffman Hwy, Bethel, AK 99559 | 2019-07-13 |
| Find all providers in BETHEL | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.