Healthcare Provider Details

I. General information

NPI: 1114681608
Provider Name (Legal Business Name): ALPINE MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2021
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 CHIEF THOMAS DR
FAIRBANKS AK
99709-4848
US

IV. Provider business mailing address

605 CHIEF THOMAS DR
FAIRBANKS AK
99709-4848
US

V. Phone/Fax

Practice location:
  • Phone: 907-455-4555
  • Fax: 833-941-2349
Mailing address:
  • Phone: 907-455-4555
  • Fax: 833-941-2349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: HALEY EVENS
Title or Position: AUTHORIZED OFFICIAL
Credential: NP
Phone: 907-455-4555