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2751 Debarr Rd Ste 300 Anchorage AK 99508-2962 | |
| (907) 206-4088 | |
| (907) 318-9956 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2751 Debarr Rd Ste 300, Anchorage, Alaska |
| Authorized Official Name and Position | Kelly Rae Johnson (CREDENTIALING DIRECTOR) |
| Authorized Official Contact | 7853206616 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
720 Poyntz Ave Apt B Manhattan KS 66502-6355 Ph: (785) 320-6616 | 2751 Debarr Rd Ste 300 Anchorage AK 99508-2962 Ph: (907) 206-4088 |
| NPI Number | 1215635875 |
|---|---|
| Provider Enumeration Date | 02/22/2023 |
| Last Update Date | 11/20/2024 |
| Certification Date | 11/20/2024 |
| Medicare PECOS PAC ID | 1759733041 |
|---|---|
| Medicare Enrollment ID | O20240123001830 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215635875 | NPI | - | NPPES |
| Provider Name | Kirk Stoner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437844909 PECOS PAC ID: 6709230113 Enrollment ID: I20241008004127 |
| Provider Name | Darian J Hawke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407553167 PECOS PAC ID: 9335673797 Enrollment ID: I20241108000400 |
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