MOOSE CREEK MEDICAL CLINIC LLC (NPI# 1053883595) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053883595 |
| Entity Type | Organization |
| Organization Name | MOOSE CREEK MEDICAL CLINIC LLC |
| Practice Address |
2341 S. Fern St., Suite 300 Wasilla AK 99654 |
| Practice Telephone | 9073733335 |
| Practice Fax Number | 9073733331 |
| Mailing Telephone | 9073733335 |
| Mailing Fax Number | 9073733331 |
| Enumeration Date | 2018-12-21 |
| Last Update Date | 2018-12-21 |
| Authorized Official Name | MRS. KIMBERLI RAYE BROCK (ADVANCED NURSE PRACTITIONER, BUSINE) |
| Authorized Official Telephone | 9073733335 |
| Authorized Official Credential | ANP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LW0102X |
Nurse Practitioner Specialization: Women's Health |
Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AK | 1022256 | 05 |
| Street Address |
2341 S. FERN ST., SUITE 300 |
| City | WASILLA |
| State | AK |
| Zip Code | 99654 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003426784 | Colleen Maggie Newcity | Case Manager/Care Coordinator | 851 Westpoint Suite 310, Wasilla, AK 99654 | 2020-08-06 |
| 1659995884 | Amy M Lowe | Peer Specialist | 1363 W Spuce Ave, Wasilla, AK 99654 | 2020-06-03 |
| 1922648690 | Achieve Medical Alaska LLC | Clinic/Center | 1981 E Palmer, Suite 230, Wasilla, AK 99654 | 2020-01-10 |
| 1588205538 | Juan Carlos Garcia | Physician Assistant | 950 East Bogard Road, Suite 103, Wasilla, AK 99654 | 2019-10-01 |
| 1427610864 | Sharon Webb | Counselor | 705 S Knik Goose Bay Rd Suite K, Wasilla, AK 99654 | 2019-07-06 |
| 1306401864 | Logan Lee Cook | Peer Specialist | 2953 E Fairview Loop, Wasilla, AK 99654 | 2019-05-09 |
| 1487124962 | Melissa A Stevens | Massage Therapist | 2201 W That Rd, Wasilla, AK 99654 | 2018-11-28 |
| 1609359561 | Audrey E Beers | Midwife | 2405 S. Knik Goose Bay Rd., Wasilla, AK 99654 | 2018-09-07 |
| 1093297418 | Karlee Janine Mccorry | Occupational Therapist | 613 S Knik-goose Bay Rd, Wasilla, AK 99654 | 2018-09-01 |
| 1144706458 | Alysia S Peppers | Licensed Practical Nurse | 3628 South Shady Lane, Wasilla, AK 99654 | 2018-07-19 |
| Find all providers in zip 99654 | ||||
| Taxonomy Code | 363LA2200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Adult Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487637948 | Darlene S. Dunn | Nurse Practitioner | 3161 E Palmer Wasilla Hwy Ste 1c, Wasilla, AK 99654-7271 | 2005-11-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992843072 | Ginger D Scoggin | Nurse Practitioner | 3658 Arctic Blvd, Anchorage, AK 99503-1111 | 2007-02-02 |
| 1134210487 | Kathy L Chastain | Nurse Practitioner | 213 East Fireweed, Suite 2, Anchorage, AK 99503 | 2006-09-28 |
| 1457452963 | Judith Beach | Nurse Practitioner | 3380 C St, Suite 100, Anchorage, AK 99503-3920 | 2006-09-26 |
| 1003855271 | Mindy Lorin Schloss | Nurse Practitioner | 6852 Cutty Sark St, Anchorage, AK 99502-2807 | 2006-06-05 |
| 1689612269 | Lori Jean Zitzmann | Nurse Practitioner | 915 W Northern Lights Blvd, Anchorage, AK 99503-2408 | 2006-06-03 |
| 1639176225 | Louise Couts Kressly | Nurse Practitioner | 4251 Warwick Dr, Anchorage, AK 99508-5162 | 2005-06-28 |
| 1619972478 | Kymberli Raye Brock | Nurse Practitioner | 3841 Piper St, Suite T100, Anchorage, AK 99508-4624 | 2005-06-17 |
| 1518515030 | Glacier Bay Medical and Diabetes Care Center LLC | Nurse Practitioner | 615 E 82nd Ave Ste 302, Anchorage, AK 99518-3159 | 2019-08-28 |
| 1427532613 | Gold Star Longevity & Wellness LLC | Nurse Practitioner | 3875 Geist Rd Ste E, Fairbanks, AK 99709-3564 | 2018-09-24 |
| 1144719535 | Katherine Smith | Nurse Practitioner | 11421 Old Glenn Hwy Ste 100, Eagle River, AK 99577-7783 | 2018-05-01 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.