Healthcare Provider Details

I. General information

NPI: 1053275545
Provider Name (Legal Business Name): FEISTY MARMOT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1867 AIRPORT WAY STE 215
FAIRBANKS AK
99701-4062
US

IV. Provider business mailing address

PO BOX 82163
FAIRBANKS AK
99708-2163
US

V. Phone/Fax

Practice location:
  • Phone: 865-474-0323
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE KAY RAST
Title or Position: PRESIDENT
Credential:
Phone: 865-474-0323