Provider Demographics
NPI:1316910482
Name:ELLERBE, JAYME G (ANP)
Entity type:Individual
Prefix:
First Name:JAYME
Middle Name:G
Last Name:ELLERBE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 DEBARR RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2959
Mailing Address - Country:US
Mailing Address - Phone:907-777-1800
Mailing Address - Fax:907-278-2066
Practice Address - Street 1:2925 DEBARR RD
Practice Address - Street 2:SUITE 230
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2959
Practice Address - Country:US
Practice Address - Phone:907-777-1800
Practice Address - Fax:907-278-2066
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKANP395363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1022443Medicaid
AK1022443Medicaid
AK152954Medicare ID - Type UnspecifiedMEDICARE GR#