Provider Demographics
NPI:1306882311
Name:MEFFLEY, PATRICIA (ANP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:MEFFLEY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:PATRICE
Other - Middle Name:
Other - Last Name:MEFFLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ANP
Mailing Address - Street 1:1524 HUSKY WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-6736
Mailing Address - Country:US
Mailing Address - Phone:907-374-7037
Mailing Address - Fax:907-374-7035
Practice Address - Street 1:1524 HUSKY WAY
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-6736
Practice Address - Country:US
Practice Address - Phone:907-374-7037
Practice Address - Fax:907-374-7035
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK715363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP79611Medicaid
AKNP79611Medicaid
S53099Medicare UPIN