1942131008 NPI number — DR. JOHNIE JOEL PRENTICE JR.

Table of content: DR. JOHNIE JOEL PRENTICE JR. (NPI 1942131008)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942131008 NPI number — DR. JOHNIE JOEL PRENTICE JR.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRENTICE
Provider First Name:
JOHNIE
Provider Middle Name:
JOEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942131008
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/27/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1289
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KOTZEBUE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99752-1289
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
436 5TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KOTZEBUE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-442-3321
Provider Business Practice Location Address Fax Number:
907-442-7309
Provider Enumeration Date:
05/27/2026

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  224938 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)