Provider Demographics
NPI:1487996906
Name:SKINNER, REAGAN T (MSN, ANP, ACNP-BC)
Entity type:Individual
Prefix:
First Name:REAGAN
Middle Name:T
Last Name:SKINNER
Suffix:
Gender:F
Credentials:MSN, ANP, ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 W TUDOR RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-6649
Mailing Address - Country:US
Mailing Address - Phone:907-743-0050
Mailing Address - Fax:907-743-0060
Practice Address - Street 1:510 W TUDOR RD
Practice Address - Street 2:SUITE 5
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-6649
Practice Address - Country:US
Practice Address - Phone:907-743-0050
Practice Address - Fax:907-743-0060
Is Sole Proprietor?:No
Enumeration Date:2013-03-22
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK117618363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care