ISLAND BEHAVIORAL HEALTH LLC NPI 1215508411

NPI Information

NPI: 1215508411
Provider Name: ISLAND BEHAVIORAL HEALTH LLC
Classification: Nurse Practitioner - 363LP0808X
Entity Type: Organization

Specialization: Psychiatric/Mental Health

Address:
702 BAYVIEW ST APT B
KETCHIKAN, AK
ZIP 99901
Phone: (907) 617-8485
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ISLAND BEHAVIORAL HEALTH LLC is a psychiatric/mental health nurse practitioner in Ketchikan, AK. ISLAND BEHAVIORAL HEALTH LLC NPI is 1215508411. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

702 BAYVIEW ST APT B
KETCHIKAN, AK
ZIP 99901-102
Phone: (907) 617-8485

The provider's authorized official is Jennie R Wilks .
The authorized official title is Nurse Practitioner/owner and has the following contact phone number (907) 617-8485.

The enumeration date for this NPI number is 7/8/2021 and was last updated on 7/8/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1715763	MEDICAID	ALASKA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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