Healthcare Provider Details

I. General information

NPI: 1760736672
Provider Name (Legal Business Name): RILEY BENNETT-VOCKNER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RILEY BENNETT

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 06/20/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 LINDBLAD AVE.
GIRDWOOD AK
99587-1130
US

IV. Provider business mailing address

6931 CHAD ST
ANCHORAGE AK
99518-2054
US

V. Phone/Fax

Practice location:
  • Phone: 907-783-1355
  • Fax:
Mailing address:
  • Phone: 907-841-0736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2225
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: