Moose Creek Medical Clinic LLC

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

Legal business name

MOOSE CREEK MEDICAL CLINIC LLC

Practice address

2341 S. Fern St., Suite 300
Wasilla, AK 99654

Phone

(907) 373-3335

Fax

(907) 373-3331

NPI assigned

Dec 21, 2018

Last updated

Dec 21, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Kimberli Raye Brock, ANP

Title

Advanced Nurse Practitioner, Busine

Phone

(907) 373-3335

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AK

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kymberli Raye Brock, NP-C

  • Family Nurse Practitioner
  • Anchorage, AK
  • NPI 1619972478

  Adult Health

  Medicare reassignment Care Compare group NPD
• Sarah Elizabeth Nielsen, APRN, IFMCP, DNP

  • Family Nurse Practitioner
  • Wasilla, AK
  • NPI 1366731218
  Medicare reassignment Care Compare group NPD
• Alysa Sonnentag, APRN

  • Family Nurse Practitioner
  • Wasilla, AK
  • NPI 1003537325
  Medicare reassignment Care Compare group NPD
• Kathryn Albert, PA-C

  • Medical Physician Assistant
  • Wasilla, AK
  • NPI 1356754618
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1545350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1545350400000",
    "number": "1053883595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2341 S. FERN ST., SUITE 300",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "99654",
            "telephone_number": "907-373-3335",
            "fax_number": "907-373-3331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2341 S. FERN ST., SUITE 300",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "99654",
            "telephone_number": "907-373-3335",
            "fax_number": "907-373-3331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOOSE CREEK MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-21",
        "last_updated": "2018-12-21",
        "status": "A",
        "authorized_official_last_name": "BROCK",
        "authorized_official_first_name": "KIMBERLI",
        "authorized_official_middle_name": "RAYE",
        "authorized_official_title_or_position": "ADVANCED NURSE PRACTITIONER, BUSINE",
        "authorized_official_telephone_number": "907-373-3335",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "ANP"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LW0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Women's Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1022256",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Judith Moore
• Martha Jane Moore, MD-MPH
• Mary Jane Moore
• Stace Lee Elizabeth Moore, LMT
• William Robert Moore
• Pamela S Mooty
• Elizabeth Moran, CNM
• Grant Robert Moravec, PT, DPT
• Sarah Moreau, CLVT, COMS
• Jennifer Leigh Morehouse

• Adult Health Nurse Practitioner in Wasilla, AK
• Providers in Wasilla, AK by specialty
• Adult Health Nurse Practitioner in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.