KIMBERLY J WONDERLICH MD FAAD DERMATOLOGY LLC (NPI# 1396124897) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396124897 |
| Entity Type | Organization |
| Organization Name | KIMBERLY J WONDERLICH MD FAAD DERMATOLOGY LLC |
| Practice Address |
2775 College Road Fairbanks AK 99709 |
| Mailing Address |
2775 College Rd Fairbanks AK 99709-3751 |
| Practice Telephone | 9074561979 |
| Mailing Telephone | 9074561979 |
| Mailing Fax Number | 9074561903 |
| Enumeration Date | 2015-05-29 |
| Last Update Date | 2019-02-13 |
| Authorized Official Name | KIMBERLY WONDERLICH (MANAGING MEMBER) |
| Authorized Official Telephone | 9074561979 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | 8102 | AK | Allopathic & Osteopathic Physicians |
| Street Address |
2775 COLLEGE ROAD |
| City | FAIRBANKS |
| State | AK |
| Zip Code | 99709 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346211505 | Kimberly Janne Wonderlich | Dermatology | 2775 College Road, Fairbanks, AK 99709 | 2006-01-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255946810 | Beacon Monitoring Professional Services | Technician, Other | 745 Staffordshire Rd, Fairbanks, AK 99709 | 2020-09-10 |
| 1235629544 | Fairbanks Healing Space | Health Educator | 3875 Geist Road, Suite E #136, Fairbanks, AK 99709 | 2018-05-11 |
| 1609395409 | Shawn K Goggins | Counselor | 1423 Peger Road, Fairbanks, AK 99709 | 2017-09-12 |
| 1710433347 | Jay Titus | Technician/Technologist | 2884 Marina Drive, Fairbanks, AK 99709 | 2016-09-01 |
| 1710391610 | Hannah Summerfelt | Dentist | 3539 Thomas St, Fairbanks, AK 99709 | 2014-06-18 |
| 1629407325 | Diane Louise Mitchell | Nurse Practitioner | 4650 Harvard Cir, Fairbanks, AK 99709 | 2013-11-04 |
| 1407147929 | Christina Martz | Counselor | 1270 Summet Drive, Fairbanks, AK 99709 | 2011-05-02 |
| 1255652285 | Surgery Center of Fairbanks LLC | Clinic/Center | 2310 Peger Road, Fairbanks, AK 99709 | 2010-06-14 |
| 1962661835 | John Leo Hughes Jr Jr. | Dentist | 3437 Airport Way, Suite 205, Fairbanks, AL 99709 | 2008-06-05 |
| 1508042417 | Katherine E Johnson, Md PC | Ophthalmology | 2485 Chief William Drive, Suite 100, Fairbanks, AK 99709 | 2008-01-10 |
| Find all providers in zip 99709 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346211505 | Kimberly Janne Wonderlich | Dermatology | 2775 College Road, Fairbanks, AK 99709 | 2006-01-27 |
| 1699061085 | Maren Kelly Ness Gaul | Dermatology | 1001 Noble St, Fairbanks, AK 99701-4948 | 2011-06-23 |
| 1205161478 | Brooke Melissa Walls | Dermatology | 1001 Noble St, Tvc, Fairbanks, AK 99701 | 2009-10-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760034045 | Swiftwater Dermatology LLC | Dermatology | 209 W Katmai Ave, Soldotna, AK 99669-7409 | 2019-07-16 |
| 1932493327 | John Schultz | Dermatology | 8501 Sultana Dr, Anchorage, AK 99516-2561 | 2011-06-03 |
| 1669669867 | Layne Bedford Green | Dermatology | 5955 Zeamer Ave Ste 1, Elmendorf Afb, AK 99506-3702 | 2007-10-02 |
| 1295881977 | Gina M Brown | Dermatology | 3340 Providence Dr Ste A358, Anchorage, AK 99508-4691 | 2007-01-26 |
| 1649212937 | Michael L Cusack | Dermatology | 110 W 38th Ave Ste A2, Anchorage, AK 99503-5677 | 2006-06-12 |
| 1154363752 | Aesthetica Medical Spa LLC | Dermatology | 110 W 38th Ave, Ste A2, Anchorage, AK 99503-5650 | 2006-06-11 |
| 1114998473 | Jayne S Fortson, Md | Dermatology | 2401 E 42nd Ave, Ste 301, Anchorage, AK 99508-5205 | 2006-01-26 |
| 1467448662 | Michael D Michener | Dermatology | 3841 Piper St Ste T4-020, Anchorage, AK 99508-4673 | 2005-09-22 |
| 1821093550 | Valley Dermatology Center, Inc. | Dermatology | 851 Westpoint Dr, Ste B10, Wasilla, AK 99654-7191 | 2005-06-17 |
| 1609420215 | Anchorage Dermatology & Cosmetics, LLC | Dermatology | 615 E 82nd Ave Ste 204, Anchorage, AK 99518-3159 | 2019-07-31 |
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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.