Healthcare Provider Details

I. General information

NPI: 1598676744
Provider Name (Legal Business Name): BRAIDED RIVER WHOLISTIC HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13764 E VETERANS WAY
TALKEETNA AK
99676-0014
US

IV. Provider business mailing address

PO BOX 14
TALKEETNA AK
99676-0014
US

V. Phone/Fax

Practice location:
  • Phone: 907-733-3764
  • Fax:
Mailing address:
  • Phone: 907-733-3764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JAYME L S MOUDY-FERRIER
Title or Position: OWNER/PRACTITIONER
Credential: LCSW
Phone: 907-733-3764