Willie Nick David
Individual provider Active NPI Counselor · Kwethluk, AK
NPI 1184901035 · NPPES record last updated Jan 15, 2014
Key facts
- NPI
- 1184901035
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- 49 Airport Road
Kwethluk, AK 99621 - Phone
- (907) 757-6627
- Fax
- (907) 757-6626
- NPI assigned
- Nov 7, 2011
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Yes |
Addresses
Primary practice location
49 Airport Road
Kwethluk, AK 99621
Mailing address
PO Box 69
Kwethluk, AK 99621
Phone (907) 757-6627
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1020986 | Medicaid | AK |
Other providers in Kwethluk, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 15, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.