ANDREW RICHARD JACONETTE (NPI# 1487778304) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487778304 |
| Entity Type | Individual |
| Full Name | ANDREW RICHARD JACONETTE |
| Credential | M.D. |
| Practice Address |
851 E Westpoint Dr Suite 203 Wasilla AK 99654-7191 |
| Mailing Address |
Po Box 210850 Anchorage AK 99521-0850 |
| Practice Telephone | 9073737934 |
| Practice Fax Number | 9076776999 |
| Mailing Telephone | 9076776900 |
| Mailing Fax Number | 9076776999 |
| Enumeration Date | 2007-03-17 |
| Last Update Date | 2017-03-20 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207LP2900X |
Anesthesiology Specialization: Pain Medicine |
5328 | AK | Allopathic & Osteopathic Physicians |
| Y | 208VP0014X |
Pain Medicine Specialization: Interventional Pain Medicine |
5328 | AK | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AK | 1016497 | 05 |
| Street Address |
851 E WESTPOINT DR SUITE 203 |
| City | WASILLA |
| State | AK |
| Zip Code | 99654-7191 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821004383 | Lisa L Harrison | Family Medicine | 851 E Westpoint Dr, Suite 310, Wasilla, AK 99654-7191 | 2006-08-01 |
| 1053963926 | Daisy Vanslyke | Counselor | 851 E Westpoint Dr, Wasilla, AK 99654-7191 | 2019-07-11 |
| 1184074189 | Arctic Pain Relief Center, LLC | Clinic/Center | 851 E Westpoint Dr, Suite B1, Wasilla, AK 99654-7191 | 2016-06-21 |
| 1003244211 | Wild Iris LLC | Family Medicine | 851 E Westpoint Dr, Suite 207, Wasilla, AK 99654-7183 | 2013-10-25 |
| 1508124587 | Eric A Nimmo Md Apc | Family Medicine | 851 E Westpoint Dr, Ste 302, Wasilla, AK 99654-7191 | 2012-04-27 |
| 1871724773 | Christi Hill, Anp Family Psychiatry LLC | Nurse Practitioner | 851 E Westpoint Dr, Ste. 208, Wasilla, AK 99654-7191 | 2009-07-27 |
| 1538359310 | Heather Brock, Inc | Nurse Practitioner | 851 E Westpoint Dr, Ste 208, Wasilla, AK 99654-7142 | 2007-07-27 |
| 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 |
| 1053883595 | Moose Creek Medical Clinic LLC | Nurse Practitioner | 2341 S. Fern St., Suite 300, Wasilla, AK 99654 | 2018-12-21 |
| 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 |
| Find all providers in zip 99654 | ||||
| Taxonomy Code | 208VP0014X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pain Medicine |
| Specialization | Interventional Pain Medicine |
| Interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790776599 | Eric F Severson | Pain Medicine | 3066 E Meridian Park Loop Ste 207, Wasilla, AK 99654-7254 | 2005-10-31 |
| 1609176783 | Algone Center | Pain Medicine | 3066 E Meridian Park Loop, #1, Wasilla, AK 99654-7299 | 2010-10-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417996307 | Tamara Ann Brothers Mcneil | Pain Medicine | 100 Trading Bay Rd Ste 8, Kenai, AK 99611-7786 | 2006-06-06 |
| 1487102208 | Neuroversion | Pain Medicine | 2925 Debarr Rd, Suite 240, Anchorage, AK 99508-2959 | 2016-09-21 |
| 1518300185 | Pain and Headache Center, LLC | Pain Medicine | 12836 Old Glenn Hwy Ste 2, Eagle River, AK 99577 | 2013-04-12 |
| 1407171069 | Northern Anesthesia and Pain Medicine, LLC | Pain Medicine | 10928 Eagle River Rd, Suite 240, Eagle River, AK 99577-8078 | 2010-04-06 |
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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.