Active NPI
Lyra Petticrew, M.ED.
- Case Manager/Care Coordinator
- Wrangell, AK
National Provider Identifier
1124237359
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- Practice address
- 110 Lynch St.
Wrangell, AK 99929-1231 - Phone
- (907) 874-3375
- Fax
- (907) 874-3339
- NPI assigned
- May 22, 2007
- 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 |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | Primary |
Addresses
Primary practice location
110 Lynch St.
Wrangell, AK 99929-1231
Mailing address
PO Box 2127
Wrangell, AK 99929-2127
Phone (907) 874-3375
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CM 1085 | 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)
- Not enrolled
- Credentials
- Master of Education
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179792000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1124237359",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2127",
"city": "WRANGELL",
"state": "AK",
"postal_code": "999292127",
"telephone_number": "907-874-3375",
"fax_number": "907-874-3339"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 LYNCH ST.",
"city": "WRANGELL",
"state": "AK",
"postal_code": "999291231",
"telephone_number": "907-874-3375",
"fax_number": "907-874-3339"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTICREW",
"first_name": "LYRA",
"credential": "M.ED.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "CM 1085",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wrangell, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.