Healthcare Provider Details

I. General information

NPI: 1992346993
Provider Name (Legal Business Name): AYLAR ANSARITALESH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2019
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16600 CENTERFIELD DR
EAGLE RIVER AK
99577-7702
US

IV. Provider business mailing address

16600 CENTERFIELD DR STE 205
EAGLE RIVER AK
99577-7702
US

V. Phone/Fax

Practice location:
  • Phone: 907-202-9238
  • Fax:
Mailing address:
  • Phone: 907-202-9238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA7450858
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number246215
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: