Provider Demographics
NPI:1760736672
Name:BENNETT-VOCKNER, RILEY (PA-C)
Entity Type:Individual
Prefix:
First Name:RILEY
Middle Name:
Last Name:BENNETT-VOCKNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RILEY
Other - Middle Name:
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6931 CHAD ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-2054
Mailing Address - Country:US
Mailing Address - Phone:907-841-0736
Mailing Address - Fax:
Practice Address - Street 1:131 LINDBLAD AVE.
Practice Address - Street 2:
Practice Address - City:GIRDWOOD
Practice Address - State:AK
Practice Address - Zip Code:99587-1130
Practice Address - Country:US
Practice Address - Phone:907-783-1355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2225363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical