Evelyn Louise Clough, ANP, CDCII
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Soldotna, AK
NPI 1124092655 · NPPES record last updated Jun 8, 2010
Key facts
- NPI
- 1124092655
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 668 (AK)
- Practice address
- 44539 Sterling Hwy
Suite 105
Soldotna, AK 99669-7938 - Phone
- (907) 262-5324
- Fax
- (907) 260-7464
- NPI assigned
- Feb 13, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1091 | AK | MD | Addiction (Substance Use Disorder) Counselor |
| 668 | AK | MD | Professional Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 1091 | AK | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 668 | AK | Yes |
Addresses
Primary practice location
44539 Sterling Hwy
Suite 105
Soldotna, AK 99669-7938
Mailing address
PO Box 1015
Soldotna, AK 99669-1015
Phone (907) 262-5324
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NP4248 | Medicaid | AK |
Other providers in Soldotna, AK
- Christina Chumley
- Chiara M Ciapponi
- Uleta Clark
- Michael Sydenham Clarke
- Lauren Elizabeth Anne Clarkson
- Lindsay Brianne Cobb
- Corey Matthew Colella
- Krista Rae Collinson
- Kevin Collis
- Farrah Kay Collver
All providers in Soldotna, AK · Psychiatric/Mental Health Nurse Practitioner in Alaska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 8, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.