Active NPI
Heather Koponen, PA-C
- Physician Assistant
- Fairbanks, AK
National Provider Identifier
1023008042
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 383
- Practice address
- 1408 19TH Ave
Fairbanks, AK 99701-5903 - Phone
- (907) 451-6682
- Fax
- (907) 459-3912
- NPI assigned
- Oct 21, 2005
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 383 | AK | Primary |
Addresses
Primary practice location
1408 19TH Ave
Fairbanks, AK 99701-5903
Mailing address
1408 19TH Ave
Fairbanks, AK 99701-5903
Phone (907) 451-6682
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 383 | AK | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129852800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1023008042",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1408 19TH AVE",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997015903",
"telephone_number": "907-451-6682",
"fax_number": "907-459-3912"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1408 19TH AVE",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997015903",
"telephone_number": "907-451-6682",
"fax_number": "907-459-3912"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOPONEN",
"first_name": "HEATHER",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-10-21",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "AK",
"license": "383",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairbanks, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.