Provider Demographics
NPI:1043621576
Name:BOLE, BECKY (ANP, PMHNP)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:
Last Name:BOLE
Suffix:
Gender:F
Credentials:ANP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11260 OLD SEWARD HWY
Mailing Address - Street 2:SUITE 107
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-3038
Mailing Address - Country:US
Mailing Address - Phone:907-433-5100
Mailing Address - Fax:907-433-5111
Practice Address - Street 1:11260 OLD SEWARD HWY
Practice Address - Street 2:SUITE 107
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-3038
Practice Address - Country:US
Practice Address - Phone:907-433-5100
Practice Address - Fax:907-433-5111
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1448363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health