CARROLLYNN CECELIA PETERSON (NPI# 1902413339) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902413339 |
| Entity Type | Individual |
| Full Name | CARROLLYNN CECELIA PETERSON |
| Practice Address |
43335 Kalifornsky Beach Rd Soldotna AK 99669-8280 |
| Practice Telephone | 9077146661 |
| Practice Fax Number | 9072626294 |
| Mailing Telephone | 9077146661 |
| Mailing Fax Number | 9072626294 |
| Enumeration Date | 2020-09-29 |
| Last Update Date | 2020-10-26 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 175T00000X | Peer Specialist | Other Service Providers |
| Street Address |
43335 KALIFORNSKY BEACH RD |
| City | SOLDOTNA |
| State | AK |
| Zip Code | 99669-8280 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598803702 | Pat Alton Truesdell | Social Worker | 43335 Kalifornsky Beach Rd, Suite 3b, Soldotna, AK 99669-8260 | 2007-02-01 |
| 1649822230 | Aurora Counseling and Consultation | Counselor | 43335 Kalifornsky Beach Rd, Soldotna, AK 99669-8280 | 2019-07-12 |
| 1710540331 | Haylee Danielle Morris | Counselor | 43335 Kalifornsky Beach Rd, Soldotna, AK 99669-8280 | 2019-04-18 |
| 1427311166 | Denia Stevens | Case Manager/Care Coordinator | 43335 Kalifornsky Beach Rd, Soldotna, AK 99669-8260 | 2012-06-18 |
| 1487964573 | Jill Vienup | Case Manager/Care Coordinator | 43335 Kalifornsky Beach Rd, Soldotna, AK 99669-8260 | 2010-10-07 |
| 1598087736 | Kara Hawley | Massage Therapist | 43335 Kalifornsky Beach Rd, Ste 25, Soldotna, AK 99669 | 2010-02-15 |
| 1790011955 | Jennifer Denny | Case Manager/Care Coordinator | 43335 Kalifornsky Beach Rd, Soldotna, AK 99669-8260 | 2009-10-22 |
| 1972738367 | Julia Echeverria | Case Manager/Care Coordinator | 43335 Kalifornsky Beach Rd, Suite 36, Soldotna, AK 99669-8260 | 2009-05-28 |
| 1780819177 | Tucker Mattox | Case Manager/Care Coordinator | 43335 Kalifornsky Beach Rd, Suite 36, Soldotna, AK 99669-8260 | 2009-05-28 |
| 1235354630 | Hope Community Resources Inc | Case Management | 43335 Kalifornsky Beach Rd, Ste 27, Soldotna, AK 99669-8260 | 2007-04-13 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881201226 | Kyle Arron Shassetz | Counselor | 43335 K-beach Rd., Soldotna, AK 99669 | 2020-09-29 |
| 1720614993 | Peninsula Instacare | Clinic/Center | 34581 Kenai Spur Hwy, Suite 1, Soldotna, AK 99669 | 2020-03-19 |
| 1871141077 | Alaine Viola Lagasse | Counselor | Kenai Vet Center, 43299 Kalifornsky Beach Road Ste 4, Soldotna, AK 99669 | 2019-08-30 |
| 1962970574 | Ryder R Storm | Behavior Technician | 338800 Community College Drive, Suite 1, Soldotna, AK 99669 | 2018-11-13 |
| 1356821540 | Tanecia Webster | Nurse Practitioner | 36570 Kenai Spur Hwy, Ste 103a, Soldotna, AK 99669 | 2018-08-16 |
| 1821519869 | Theresa Napolitano | Case Manager/Care Coordinator | 35477 Kenai Spur Hwy Suite 203, Soldotna, AK 99669 | 2017-06-29 |
| 1689048282 | Jeanne Bignell | Licensed Practical Nurse | 35020 Alaskan View Lane, Soldotna, AK 99669 | 2015-11-19 |
| 1952786105 | Ian Charles Mcmullen | Pharmacist | 44001 Sterling Highway, Soldotna, AK 99669 | 2015-07-29 |
| 1841679933 | Lana Clymer | Case Manager/Care Coordinator | 22994 Kalifornsky Beach Rd, Soldotna, AK 99669 | 2015-05-22 |
| 1861800773 | Phillip Bruce | Physical Therapy Assistant | 35105 Kenai Spury Hwy, Suite A, Soldotna, AK 99669 | 2014-07-24 |
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| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891395885 | Troy Lee Bailey | Peer Specialist | 43335 Kalifornsky Beach Rd Ste 36, Soldotna, AK 99669-8280 | 2020-10-28 |
| 1770180192 | Nicole Marcano | Peer Specialist | 43335 K Beach Rd, Soldotna, AK 99669-8280 | 2020-10-08 |
| 1497352231 | Pierce James Svec | Peer Specialist | 43335 K Beach Rd Ste 36, Soldotna, AK 99669-8280 | 2020-10-05 |
| 1174120984 | Ronald Paul | Peer Specialist | 43335 K Beach Rd Ste 36, Soldotna, AK 99669-8280 | 2020-10-05 |
| 1710584727 | Amanda Starr-marrie Wilcox | Peer Specialist | 43335 K Beach Rd Ste 36, Soldotna, AK 99669-8280 | 2020-10-02 |
| 1528665536 | Christian Kelly Foldenauer | Peer Specialist | 43335 K Beach Rd Ste 36, Soldotna, AK 99669-8280 | 2020-10-02 |
| 1720685738 | Christina Wells | Peer Specialist | 43335 K Beach Rd Ste 36, Soldotna, AK 99669-8280 | 2020-10-02 |
| 1487261582 | Christina Marie Svec | Peer Specialist | 43335 K Beach Rd Ste 36, Soldotna, AK 99669-8280 | 2020-09-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851998223 | Patricia Main | Peer Specialist | 2601 W 34th Ave Apt 7, Anchorage, AK 99517-2142 | 2020-10-07 |
| 1215552526 | Joshua Dee Engle | Peer Specialist | 1419 S Kittiwake St, Wasilla, AK 99623-9302 | 2020-06-11 |
| 1659995884 | Amy M Lowe | Peer Specialist | 1363 W Spuce Ave, Wasilla, AK 99654 | 2020-06-03 |
| 1699399303 | Jennifer Benton | Peer Specialist | 11932 Town Park Cir, Eagle River, AK 99577-7788 | 2020-05-29 |
| 1104449800 | Aubrey Danielle Cave | Peer Specialist | 5752 W Kranberry Ln, Wasilla, AK 99623-1050 | 2020-05-28 |
| 1811534803 | Colleen H Ward-wilson | Peer Specialist | 3600 San Jeronimo Dr Ste 300, Anchorage, AK 99508-2870 | 2019-12-09 |
| 1538701222 | Betty Jo Shepherd-hebb | Peer Specialist | 4110 Debarr Rd Spc G17, Anchorage, AK 99508-3176 | 2019-10-14 |
| 1629610563 | Mikko Joseph Barribeau | Peer Specialist | 2762 N Azurite Cir, Wasilla, AK 99654-4540 | 2019-10-11 |
| 1194366088 | Matalena Suitupe Lokeni | Peer Specialist | 7650 Mayfair Dr Apt C, Anchorage, AK 99502-7212 | 2019-10-02 |
| 1285280784 | Zoe Dixon | Peer Specialist | 15765 Kingsley Rd, Ninilchik, AK 99639 | 2019-08-12 |
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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.