Provider Demographics
NPI:1316597412
Name:JENNIFER BYERS ANP LLC
Entity Type:Organization
Organization Name:JENNIFER BYERS ANP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANP
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BYERS
Authorized Official - Suffix:
Authorized Official - Credentials:ANP/PMHNP
Authorized Official - Phone:907-841-8663
Mailing Address - Street 1:1689 S KNIK GOOSE BAY RD
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-8088
Mailing Address - Country:US
Mailing Address - Phone:907-841-8663
Mailing Address - Fax:907-318-1102
Practice Address - Street 1:1689 S KNIK GOOSE BAY RD STE 700
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8088
Practice Address - Country:US
Practice Address - Phone:907-841-8663
Practice Address - Fax:907-318-1102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-19
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty