GOLD STAR LONGEVITY & WELLNESS LLC (NPI# 1427532613) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427532613 |
| Entity Type | Organization |
| Organization Name | GOLD STAR LONGEVITY & WELLNESS LLC |
| Practice Address |
3875 Geist Rd Ste E Fairbanks AK 99709-3564 |
| Practice Telephone | 3034726424 |
| Mailing Telephone | 3034726424 |
| Enumeration Date | 2018-09-24 |
| Last Update Date | 2018-09-24 |
| Authorized Official Name | CASEY EUGENE BLOOD (OWNER) |
| Authorized Official Telephone | 3034726424 |
| Authorized Official Credential | FNP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LC1500X |
Nurse Practitioner Specialization: Community Health |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LG0600X |
Nurse Practitioner Specialization: Gerontology |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
3875 GEIST RD STE E |
| City | FAIRBANKS |
| State | AK |
| Zip Code | 99709-3564 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679644108 | Steven J Jay | Pediatrics | 3875 Geist Rd Ste E, Box 353, Fairbanks, AK 99709-3564 | 2006-11-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255946810 | Beacon Monitoring Professional Services | Technician, Other | 745 Staffordshire Rd, Fairbanks, AK 99709 | 2020-09-10 |
| 1235629544 | Fairbanks Healing Space | Health Educator | 3875 Geist Road, Suite E #136, Fairbanks, AK 99709 | 2018-05-11 |
| 1609395409 | Shawn K Goggins | Counselor | 1423 Peger Road, Fairbanks, AK 99709 | 2017-09-12 |
| 1710433347 | Jay Titus | Technician/Technologist | 2884 Marina Drive, Fairbanks, AK 99709 | 2016-09-01 |
| 1710391610 | Hannah Summerfelt | Dentist | 3539 Thomas St, Fairbanks, AK 99709 | 2014-06-18 |
| 1629407325 | Diane Louise Mitchell | Nurse Practitioner | 4650 Harvard Cir, Fairbanks, AK 99709 | 2013-11-04 |
| 1407147929 | Christina Martz | Counselor | 1270 Summet Drive, Fairbanks, AK 99709 | 2011-05-02 |
| 1255652285 | Surgery Center of Fairbanks LLC | Clinic/Center | 2310 Peger Road, Fairbanks, AK 99709 | 2010-06-14 |
| 1962661835 | John Leo Hughes Jr Jr. | Dentist | 3437 Airport Way, Suite 205, Fairbanks, AL 99709 | 2008-06-05 |
| 1508042417 | Katherine E Johnson, Md PC | Ophthalmology | 2485 Chief William Drive, Suite 100, Fairbanks, AK 99709 | 2008-01-10 |
| Find all providers in zip 99709 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710535380 | Peter Harvey | Nurse Practitioner | 755 Knightsbridge Rd, Fairbanks, AK 99709-2477 | 2019-08-27 |
| 1942765052 | Jamie Marie Bourque | Nurse Practitioner | 1788 Yukon Drive, Fairbanks, AK 99775-5580 | 2019-02-02 |
| 1821588989 | Corrie Wilson | Nurse Practitioner | 1025 Barnette Street, Fairbanks, AK 99701 | 2018-05-15 |
| 1134667165 | Lauren Westrom | Nurse Practitioner | 1587 Drouin Rd, Fairbanks, AK 99709-5953 | 2017-02-10 |
| 1811356330 | Joseph Grimes | Nurse Practitioner | 132 Foran Cir, Fairbanks, AK 99712-2404 | 2016-02-11 |
| 1922482330 | Anna Fath | Nurse Practitioner | 5165 Palo Verde Ave, Fairbanks, AK 99709-3130 | 2015-07-15 |
| 1629407325 | Diane Louise Mitchell | Nurse Practitioner | 4650 Harvard Cir, Fairbanks, AK 99709 | 2013-11-04 |
| 1457490328 | Donna M Patrick | Nurse Practitioner | 612 N. Chandalar, Fairbanks, AK 99775-5580 | 2007-02-06 |
| 1841337334 | Nancy Prudence Bayer | Nurse Practitioner | 612 North Chandalar Ave, Fairbanks, AK 99775-5580 | 2007-01-31 |
| 1295769859 | Victoria Anne Wallace | Nurse Practitioner | 1931 Eagan Ave, Fairbanks Correctional Center, Fairbanks, AK 99701-5703 | 2006-07-10 |
| Find all providers in FAIRBANKS | ||||
Please comment or provide details below to improve the information on GOLD STAR LONGEVITY & WELLNESS LLC.
| 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.