Provider Demographics
NPI:1144362336
Name:MYHEALTH CLINIC, LLC
Entity type:Organization
Organization Name:MYHEALTH CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JYLL
Authorized Official - Middle Name:K
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:907-248-2482
Mailing Address - Street 1:2105 E 88TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507
Mailing Address - Country:US
Mailing Address - Phone:907-248-2482
Mailing Address - Fax:907-248-0045
Practice Address - Street 1:2105 E 88TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507
Practice Address - Country:US
Practice Address - Phone:907-248-2482
Practice Address - Fax:907-248-0045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK859363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP19832Medicaid
AKNP19832Medicaid