Healthcare Provider Details

I. General information

NPI: 1871529628
Provider Name (Legal Business Name): YAKUTAT TRIBAL HEALTH BOARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 06/30/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 AIRPORT RD
YAKUTAT AK
99689
US

IV. Provider business mailing address

PO BOX 112
YAKUTAT AK
99689-0112
US

V. Phone/Fax

Practice location:
  • Phone: 907-784-3275
  • Fax: 907-784-3263
Mailing address:
  • Phone: 907-784-3275
  • Fax: 907-784-3263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number288254
License Number StateAK

VIII. Authorized Official

Name: CATHY WASSILLIE
Title or Position: FINANCE MANAGER
Credential:
Phone: 907-784-3275