| Wendell Street Psychiatric Llc | |
|
225 Wendell St Ste B Fairbanks AK 99701-4835 | |
| (907) 455-4135 | |
| (907) 455-4115 |
| Full Name | Wendell Street Psychiatric Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 225 Wendell St, Fairbanks, Alaska |
| Authorized Official Name and Position | Mikki King Barker (OWNER PRESIDENT) |
| Authorized Official Contact | 9074554135 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wendell Street Psychiatric Llc 225 Wendell St Ste B Fairbanks AK 99701-4835 Ph: (907) 455-4135 | Wendell Street Psychiatric Llc 225 Wendell St Ste B Fairbanks AK 99701-4835 Ph: (907) 455-4135 |
| NPI Number | 1568671766 |
|---|---|
| Provider Enumeration Date | 05/22/2007 |
| Last Update Date | 08/08/2007 |
| Medicare PECOS PAC ID | 3971604471 |
|---|---|
| Medicare Enrollment ID | O20070727000621 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568671766 | NPI | - | NPPES |
| Provider Name | Mikki Barker |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1639240740 PECOS PAC ID: 1658306642 Enrollment ID: I20050928000940 |
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