| Identity Health Clinic | |
|
307 E Northern Lights Blvd Ste 101 Anchorage AK 99503-2701 | |
| (907) 865-3247 | |
| (833) 992-2022 |
| Full Name | Identity Health Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 307 E Northern Lights Blvd Ste 101, Anchorage, Alaska |
| Authorized Official Name and Position | Lynn Murphy (OPERATIONS DIRECTOR) |
| Authorized Official Contact | 9079294528 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Identity Health Clinic 801 W Fireweed Ln Ste 103 Anchorage AK 99503-1893 Ph: (452) 890-7929 | Identity Health Clinic 307 E Northern Lights Blvd Ste 101 Anchorage AK 99503-2701 Ph: (907) 865-3247 |
| NPI Number | 1225633449 |
|---|---|
| Provider Enumeration Date | 12/04/2020 |
| Last Update Date | 03/11/2022 |
| Medicare PECOS PAC ID | 5395150460 |
|---|---|
| Medicare Enrollment ID | O20210223001828 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225633449 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| Provider Name | Tracey Lauren Wiese |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467781021 PECOS PAC ID: 7315075843 Enrollment ID: I20100504000715 |
| Provider Name | Crystal J Beal |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609130723 PECOS PAC ID: 5991025017 Enrollment ID: I20200512003702 |
| Provider Name | Monica Holloway Perez-verdia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508316324 PECOS PAC ID: 4587083373 Enrollment ID: I20200928003069 |
| Provider Name | Jennifer Talley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699498055 PECOS PAC ID: 3779946280 Enrollment ID: I20230831001555 |
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