Healthcare Provider Details

I. General information

NPI: 1417836594
Provider Name (Legal Business Name): TARYN HICKS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2025
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 BRAGAW ST
ANCHORAGE AK
99508-3435
US

IV. Provider business mailing address

17537 TEKLANIKA DR
EAGLE RIVER AK
99577-8129
US

V. Phone/Fax

Practice location:
  • Phone: 907-795-6966
  • Fax:
Mailing address:
  • Phone: 907-795-6966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number230653
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: