Active NPI
Kelton Hillard Oliver, MD
- Family Medicine Physician
- Anchorage, AK
National Provider Identifier
1013930841
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 5313
- Practice address
- 12302 Woodward Dr
Anchorage, AK 99516-1957 - Phone
- (907) 580-0002
- NPI assigned
- Jul 25, 2006
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 5313 | AK | Primary |
Addresses
Primary practice location
12302 Woodward Dr
Anchorage, AK 99516-1957
Mailing address
12302 Woodward Dr
Anchorage, AK 99516-1957
Phone (907) 580-0002
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MD6076 | Medicaid | AK |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5313 | AK | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610668800000",
"number": "1013930841",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12302 WOODWARD DR",
"city": "ANCHORAGE",
"state": "AK",
"postal_code": "995161957",
"telephone_number": "907-580-0002"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12302 WOODWARD DR",
"city": "ANCHORAGE",
"state": "AK",
"postal_code": "995161957",
"telephone_number": "907-580-0002"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLIVER",
"first_name": "KELTON",
"middle_name": "HILLARD",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-25",
"last_updated": "2021-01-15",
"certification_date": "2021-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "AK",
"license": "5313",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "MD6076",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Anchorage, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.