Active NPI
Crystale Marie Klutsch
- Community Health Worker
- Dillingham, AK
National Provider Identifier
1144664392
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- 08-979-IV
- Practice address
- 6000 Kanakanak Rd
Dillingham, AK 99576-0130 - Phone
- (907) 842-9217
- Fax
- (907) 842-9250
- NPI assigned
- Apr 18, 2013
- Last updated
- Nov 6, 2019
- 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 |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 08-979-IV | AK | Primary |
Addresses
Primary practice location
6000 Kanakanak Rd
Dillingham, AK 99576-0130
Mailing address
P.O. Box 130
Dillingham, AK 99576-0130
Phone (907) 842-9217
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
| License | State | Type | Specialty |
|---|---|---|---|
| 08-979-IV | AK | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1366243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1572998400000",
"number": "1144664392",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 130",
"city": "DILLINGHAM",
"state": "AK",
"postal_code": "995760130",
"telephone_number": "907-842-9217",
"fax_number": "907-842-9250"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6000 KANAKANAK RD",
"city": "DILLINGHAM",
"state": "AK",
"postal_code": "995760130",
"telephone_number": "907-842-9217",
"fax_number": "907-842-9250"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KLUTSCH",
"first_name": "CRYSTALE",
"middle_name": "MARIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-04-18",
"last_updated": "2019-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "AK",
"license": "08-979-IV",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dillingham, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.