Provider Demographics
NPI:1407109440
Name:ALASKA DEVELOPMENTAL BEHAVIORAL PEDIATRICS
Entity Type:Organization
Organization Name:ALASKA DEVELOPMENTAL BEHAVIORAL PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:E
Authorized Official - Last Name:HIRST
Authorized Official - Suffix:
Authorized Official - Credentials:CPNP
Authorized Official - Phone:866-251-2425
Mailing Address - Street 1:19202 MCCRARY RD
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7947
Mailing Address - Country:US
Mailing Address - Phone:866-251-2424
Mailing Address - Fax:
Practice Address - Street 1:19202 MCCRARY RD
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7947
Practice Address - Country:US
Practice Address - Phone:866-251-2424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK652363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty