Healthcare Provider Details

I. General information

NPI: 1013902758
Provider Name (Legal Business Name): CHRISTINE M BABCOCK A.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 03/07/2023
Certification Date: 07/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 LAKE ST
KENAI AK
99611-6937
US

IV. Provider business mailing address

506 LAKE ST
KENAI AK
99611-6937
US

V. Phone/Fax

Practice location:
  • Phone: 907-714-4025
  • Fax: 907-335-0064
Mailing address:
  • Phone: 907-714-4025
  • Fax: 907-335-0064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number175
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: