Active NPI
Theresa Kobuk
- Community Health Worker
- Saint Michael, AK
National Provider Identifier
1174944771
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- 12-1218-III
- Practice address
- 94 Main Street
Saint Michael, AK 99659 - Phone
- (907) 923-3311
- Fax
- (907) 923-2287
- NPI assigned
- Dec 27, 2013
- Last updated
- Dec 27, 2013
- 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 | 12-1218-III | AK | Primary |
Addresses
Primary practice location
94 Main Street
Saint Michael, AK 99659
Mailing address
94 Main Street
Saint Michael, AK 99659
Phone (907) 923-3311
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12-1218-III | Other | AK | CHA III |
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 |
|---|---|---|---|
| 12-1218-III | AK | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1388102400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1388102400000",
"number": "1174944771",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "94 MAIN STREET",
"city": "SAINT MICHAEL",
"state": "AK",
"postal_code": "99659",
"telephone_number": "907-923-3311",
"fax_number": "907-923-2287"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "94 MAIN STREET",
"city": "SAINT MICHAEL",
"state": "AK",
"postal_code": "99659",
"telephone_number": "907-923-3311",
"fax_number": "907-923-2287"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOBUK",
"first_name": "THERESA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-12-27",
"last_updated": "2013-12-27",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "AK",
"license": "12-1218-III",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHA III",
"identifier": "12-1218-III",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Michael, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.