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General NPI Number Information
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NPI Number | 1104324177
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Entity Type | Individual
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Provider Name | TABATHA SCHELLENGER PMHNP
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Gender | Female
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Dates
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Enumeration Date | 01/25/2018
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Last Update Date | 01/25/2018
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Provider Practice Location Address
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Address Line | 3200 PROVIDENCE DR
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City | ANCHORAGE
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State | AK
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Zip | 99508-4615
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Country | US
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Telephone | 907-212-7994
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Fax |
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Provider Business Mailing Address
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Address Line | 600 S STAMPER DR
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City | WASILLA
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State | AK
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Zip | 99654-7763
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Country | US
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Telephone | 907-230-5681
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | NURR29743
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 128108
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License Number State | AK
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