Robert Anthony Stephan Jr.

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

Practice address

101 Indian Creek Rd
Tyonek, AK 99682

Phone

(907) 583-2461

Fax

(907) 583-2115

NPI assigned

Jan 7, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1609977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681084800000",
    "number": "1215525936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7033 E TUDOR RD",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995071262",
            "telephone_number": "907-729-8901",
            "fax_number": "907-729-6353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 INDIAN CREEK RD",
            "city": "TYONEK",
            "state": "AK",
            "postal_code": "99682",
            "telephone_number": "907-583-2461",
            "fax_number": "907-583-2115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEPHAN",
        "first_name": "ROBERT",
        "middle_name": "ANTHONY",
        "name_suffix": "Jr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-01-07",
        "last_updated": "2023-04-10",
        "certification_date": "2023-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chrystal Marie Moon, CHA IV
• Native Village of Tyonek
• Southcentral Foundation
• Southcentral Foundation
• Southcentral Foundation
• Kimberly Shayd Ulery, CHA III

• Community Health Worker in Tyonek, AK
• Providers in Tyonek, AK by specialty
• Community Health Worker in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.