Provider Demographics
NPI:1629039771
Name:ROSCOE, KRISTA F (ANP)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:F
Last Name:ROSCOE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:4710 BUSINESS PARK BLVD
Mailing Address - Street 2:F24
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-7124
Mailing Address - Country:US
Mailing Address - Phone:907-646-2550
Mailing Address - Fax:907-562-1319
Practice Address - Street 1:4100 LAKE OTIS PKWY
Practice Address - Street 2:US HEALTHWORKS MEDICAL GROUP OF AK LLC #322
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5222
Practice Address - Country:US
Practice Address - Phone:907-562-1234
Practice Address - Fax:907-561-8550
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AKAK0563363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKK151050Medicare ID - Type Unspecified
S91872Medicare UPIN