Healthcare Provider Details

I. General information

NPI: 1407485774
Provider Name (Legal Business Name): MICHELLE ELIZABETH MOYER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELLE ELIZABETH TURNER D.O.

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 N FIREWEED ST
SOLDOTNA AK
99669-7540
US

IV. Provider business mailing address

250 HOSPITAL PL
SOLDOTNA AK
99669-7559
US

V. Phone/Fax

Practice location:
  • Phone: 907-714-5950
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberBP10072238
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberT8895
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number221403
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: