Individual provider Active NPI

Mary Josephine Morganreynolds, REGISTERED NURSE

  • Registered Nurse
  • Fairbanks, AK
National Provider Identifier
1124215678
Registry record updated Sep 28, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
4355 Issued in DC
Practice address
1408 19TH Ave
Fairbanks, AK 99701-5903
Phone
(907) 451-6682
NPI assigned
Sep 28, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 4355 DC 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

Other names 1

  • Mrs. Mary Josephine Morganreynolds Professional name

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
4355DCMDRegistered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1190937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190937600000",
    "number": "1124215678",
    "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"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORGANREYNOLDS",
        "first_name": "MARY",
        "middle_name": "JOSEPHINE",
        "name_prefix": "Mrs.",
        "credential": "REGISTERED NURSE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-28",
        "last_updated": "2007-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "DC",
            "license": "4355",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "MORGANREYNOLDS",
            "middle_name": "JOSEPHINE",
            "prefix": "MRS.",
            "credential": "REGISTERED NURSE",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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 Sep 28, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.