Active NPI
Carey Lynn Martin, CRNA
- Certified Registered Nurse Anesthetist
- Ketchikan, AK
National Provider Identifier
1003899139
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 39484
- Practice address
- 3100 Tongass Ave
Ketchikan, AK 99901-5746 - Phone
- (907) 228-7634
- Fax
- (907) 228-8332
- NPI assigned
- Nov 22, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 39484 | TX | Primary |
Addresses
Primary practice location
3100 Tongass Ave
Ketchikan, AK 99901-5746
Mailing address
3100 Tongass Ave
Ketchikan, AK 99901-5746
Phone (907) 228-7634
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 109706502 | Medicaid | TX | |
| 80224C | Other | TX | BC/BS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39484 | TX | MD | Certified Registered Nurse Anesthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132617600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1276646400000",
"number": "1003899139",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3100 TONGASS AVE",
"city": "KETCHIKAN",
"state": "AK",
"postal_code": "999015746",
"telephone_number": "907-228-7634",
"fax_number": "907-228-8332"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3100 TONGASS AVE",
"city": "KETCHIKAN",
"state": "AK",
"postal_code": "999015746",
"telephone_number": "907-228-7634",
"fax_number": "907-228-8332"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "CAREY",
"middle_name": "LYNN",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-22",
"last_updated": "2010-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "TX",
"license": "39484",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "109706502",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS",
"identifier": "80224C",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ketchikan, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.