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General NPI Number Information
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NPI Number | 1720992811
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Entity Type | Organization
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Legal Business Name | NORTHERN PSYCHIATRY, LLC
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Dates
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Enumeration Date | 09/28/2026
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Last Update Date | 09/28/2026
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Provider Practice Location Address
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Address Line | 991 S HERMON RD STE 6
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City | WASILLA
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State | AK
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Zip | 99654-7385
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Country | US
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Telephone | 907-416-3462
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Fax |
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Provider Business Mailing Address
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Address Line | 2521 E MOUNTAIN VILLAGE DR STE B926
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City | WASILLA
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State | AK
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Zip | 99654-7373
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Country | US
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Telephone | 907-952-8944
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | JESSE COOPER
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Credential | APRN
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Telephone | 907-952-8944
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State | NULL
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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 |
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License Number State | NULL
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