Organization
ISLAND BEHAVIORAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JENNIE R WILKS PMHNP-BC (NURSE PRACTITIONER/OWNER)
(907) 617-8485
Entity
Organization
Contact information
Practice address
702 BAYVIEW ST APT B, KETCHIKAN, AK 99901-6102
(907) 617-8485
Mailing address
702 BAYVIEW ST APT B, KETCHIKAN, AK 99901-6102
(907) 617-8485
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1715763
—
AK
Enumeration date
07/08/2021
Last updated
07/08/2021
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