Alice Raven Kenneally, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

233490 Issued in AK

Practice address

425 E Dahlia Ave
Palmer, AK 99645-6463

Phone

(907) 376-2411

NPI assigned

Aug 3, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

East Carolina University School of Dentistry, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Select Physical Therapy Holdings IncGroup PAC ID 9537076401, shared by 76 NPIs, 1,992 clinicians

Mat - Su Health Services Inc.Group PAC ID 2567354533, 30 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ancora Home Health & Hospice Home health agency, Wasilla, AK, CCN 027008
• Mat-Su Regional Medical Center Hospital, Palmer, AK, CCN 020006

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Interoperability endpoints

• Direct secure messaging: alice.kenneally.p1@direct.mshs.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mat - Su Health Services Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Wasilla, AK
  • NPI 1184725210
  Medicare reassignment Care Compare group

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Ancora Home Health & Hospice, LLC

  • Home Health Agency
  • Wasilla, AK
  • NPI 1801380043
  Care Compare affiliation
• Mat-Su Valley Medical Center LLC

  • General Acute Care Hospital
  • Palmer, AK
  • NPI 1417975061
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1722643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745971200000",
    "number": "1295565471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 E DAHLIA AVE",
            "city": "PALMER",
            "state": "AK",
            "postal_code": "996456463",
            "telephone_number": "907-376-2411",
            "fax_number": "907-352-3301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 E DAHLIA AVE",
            "city": "PALMER",
            "state": "AK",
            "postal_code": "996456463",
            "telephone_number": "907-376-2411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEALLY",
        "first_name": "ALICE",
        "middle_name": "RAVEN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-03",
        "last_updated": "2025-04-30",
        "certification_date": "2025-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AK",
            "license": "233490",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carla Beth Kelly
• Marisa Mae Kelly, RN
• Owen Kelly
• Vaughn William Kelly, FNP
• Heidi Jo Kemble, LMT
• Mary E. Kenshalo
• Colleen Kersgard, MD
• William Kerst, PH.D.
• Farhoud Khosravi, D.O.
• Kids First Corp

• Physician Assistant in Palmer, AK
• Providers in Palmer, AK by specialty
• Physician Assistant in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.