Individual
STACY TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
460 RIDGECREST DRIVE, SUITE 209, BETHEL, AK 99559-0528
(907) 543-1777
(907) 543-1276
Mailing address
PO BOX 528, ATTN: BH FIT PROGRAM, BETHEL, AK 99559-0528
(907) 543-1777
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1002573
—
AK
Enumeration date
05/13/2016
Last updated
05/13/2016
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