Provider Demographics
NPI:1265666366
Name:STITT, JANINE PAULETTE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:PAULETTE
Last Name:STITT
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 N. JESSICA BROOKE CIRCLE
Mailing Address - Street 2:SUITE F
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-5904
Mailing Address - Country:US
Mailing Address - Phone:907-376-9919
Mailing Address - Fax:907-376-9911
Practice Address - Street 1:4320 DIPLOMACY DR
Practice Address - Street 2:SUITE #1500
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5925
Practice Address - Country:US
Practice Address - Phone:907-729-8607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX688757363LP0808X
AK1124363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK102236Medicaid
12743679OtherCAQH PROVIDER ID
AKNPO154Medicaid
AKNPO154Medicaid
AK8EM104Medicare PIN
12743679OtherCAQH PROVIDER ID
AK8EM106Medicare PIN
AK8EM105Medicare PIN
AK102236Medicaid
AK8EM108Medicare PIN
AKMS2661824OtherDEA
AKNPO154Medicaid