Provider Demographics
NPI:1013902758
Name:BABCOCK, CHRISTINE M (ANP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:BABCOCK
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-6937
Mailing Address - Country:US
Mailing Address - Phone:907-714-4025
Mailing Address - Fax:907-335-0064
Practice Address - Street 1:506 LAKE ST
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-6937
Practice Address - Country:US
Practice Address - Phone:907-714-4025
Practice Address - Fax:907-335-0064
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK175363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
162271OtherMEDICARE
AK175OtherALASKA LICENSE #
920077523OtherTAX ID
AKNP39991Medicaid
AK1255528733OtherNPI GROUP NUMBER
AKMDG830Medicaid
AK152261OtherMEDICARE GROUP NUMBER
AK152261OtherMEDICARE GROUP NUMBER
AK152261OtherMEDICARE GROUP NUMBER
162271OtherMEDICARE