Active NPI
Krystle Velasco
- Assisted Living Facility (Mental Illness)
- Anchorage, AK
National Provider Identifier
1164720629
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Assisted Living Facility (Mental Illness)
- License
- 100852
- Practice address
- 1616 Parkway Dr
Anchorage, AK 99504-2834 - Phone
- (907) 753-8888
- NPI assigned
- Mar 8, 2011
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Assisted Living Facility (Mental Illness) | 3104A0625X | 100852 | AK | Primary |
Addresses
Primary practice location
1616 Parkway Dr
Anchorage, AK 99504-2834
Mailing address
1616 Parkway Dr
Anchorage, AK 99504-2834
Phone (907) 753-8888
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PENDING | 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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 100852 | AK | MD | Assisted Living Facility (Mental Illness) |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1299542400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1299542400000",
"number": "1164720629",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1616 PARKWAY DR",
"city": "ANCHORAGE",
"state": "AK",
"postal_code": "995042834",
"telephone_number": "907-753-8888"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1616 PARKWAY DR",
"city": "ANCHORAGE",
"state": "AK",
"postal_code": "995042834",
"telephone_number": "907-753-8888"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VELASCO",
"first_name": "KRYSTLE",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-03-08",
"last_updated": "2011-03-08",
"status": "A"
},
"taxonomies": [
{
"code": "3104A0625X",
"taxonomy_group": "",
"desc": "Assisted Living Facility, Assisted Living, Mental Illness",
"state": "AK",
"license": "100852",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PENDING",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Anchorage, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.