Healthcare Provider Details

I. General information

NPI: 1386020352
Provider Name (Legal Business Name): STACY NEWBERN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACY JOHNSTON RN

II. Dates (important events)

Enumeration Date: 07/31/2015
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 N BINKLEY ST STE 101
SOLDOTNA AK
99669-7500
US

IV. Provider business mailing address

250 HOSPITAL PL
SOLDOTNA AK
99669-6999
US

V. Phone/Fax

Practice location:
  • Phone: 907-714-4111
  • Fax: 615-904-6022
Mailing address:
  • Phone: 406-301-3941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number30070
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: