Provider Demographics
NPI:1568630762
Name:BAGLEY, RALPH (ANP)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:
Last Name:BAGLEY
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 W 7TH AVE
Mailing Address - Street 2:SUITE 601
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-3514
Mailing Address - Country:US
Mailing Address - Phone:907-269-7342
Mailing Address - Fax:907-269-7321
Practice Address - Street 1:550 W 7TH AVE
Practice Address - Street 2:SUITE 601
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-3514
Practice Address - Country:US
Practice Address - Phone:907-269-7342
Practice Address - Fax:907-269-7321
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK997363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health