Provider Demographics
NPI:1306811732
Name:GHO, STEPHANIE (PA-C)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:GHO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 PHILLIPS FIELD RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-3933
Mailing Address - Country:US
Mailing Address - Phone:907-459-3507
Mailing Address - Fax:907-459-3532
Practice Address - Street 1:1650 COWLES ST
Practice Address - Street 2:SUITE 300
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5999
Practice Address - Country:US
Practice Address - Phone:907-458-5178
Practice Address - Fax:907-458-5180
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK464363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMDA0008Medicaid
MG0408509OtherDEA NUMBER
AKK151288Medicare PIN
AKS84826Medicare UPIN
AKMDA0008Medicaid