MEDICARE: CARLENE ANN MOTT FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	PENDING	MO
2	363LF0000X	Family Nurse Practitioner	895242	NV
3	363LF0000X	Family Nurse Practitioner	197411	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NONE	OTHER		NONE
2	PENDING	OTHER	MO	PENDING

General Provider Information

NPI Number	:	1295465797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLENE ANN MOTT FNP-BC

Provider Business Mailing Address
First Line	:	9150 JEWEL LAKE RD STE B
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99502-5337
Country	:	US
Telephone Number	:	907-248-8561
Fax Number	:	907-248-8563

Provider Business Practice Location Address
First Line	:	9150 JEWEL LAKE RD STE B
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99502-5337
Country	:	US
Telephone Number	:	907-248-8561
Fax Number	:	907-248-8563

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2022
Last Update Date	:	04/07/2026

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Directions to “ CARLENE ANN MOTT FNP-BC” Practice Location

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